ABSTRACT
Efficacy of Intrathecal Baclofen (ITB) in mixed dystonia/spasticity syndromes such as those seen in severe cerebral palsy and traumatic and hypoxic brain injury cases may be less than optimal, with high dosage requirements and increased complication rates. Several reported cases of people with disorders of consciousness including persistent vegetative states who received ITB to control spasticity and subsequently went on to have dramatic improvements in consciousness have raised speculation around the mechanism for such changes. Before undertaking an ITB trial, the individual needs to understand what the whole process involves. This requires detailed explanation of the different stages: the trial, the implant, pump replacement and ongoing follow-up. The successful use of intrathecal phenol to reduce pain and spasticity was first reported in the 1950s99–101; however, due to the inherent destructive nature of phenol, it was never completely accepted into the routine care of people with severe spasticity, despite further reports of benefit from clinicians over the years.
