Intrathecal baclofen for severe spasticity: A meta-analysis

In order to evaluate the potential of intrathecal baclofen (IB) for treatment of severe spasticity, we meta-analyzed English-language literature and found that IB significantly reduces spasticity in most cases, reducing the mean Ashworth score from 3.9 to 1.6 (t-test: p ≤ .001) and the mean Penn spasm score from 3.2 to 0.6 (p < .001). No effectiveness differences by age or time since onset were evident; however, persons with cerebral palsy appear to experience less relief than do other diagnostic categories. Although 92% of all cases have a significant reduction in spasticity, a minority (8%) decide against implantation of a pump, and of those implanted, 8% discontinue treatment by one year, resulting in an overall 78% success rate. Dosage creep is about 15% per month, on average. Our conclusion is that lB is effective for treating spasticity but less so than previously, claimed. Quantitative data to evaluate its effect on pain, comfort, and function are largely lacking. Further research on longer term effects, and complications, is necessary.