Continuous Intrathecal Baclofen (ITB) Infusion for severe spasticity and dystonia. Health Technology Assessment Report - Malaysia
(2014; 162 pages)


The control of spasticity and dystonia progresses from less to more invasive treatments. Oral baclofen results in virtually undetectable levels of the drug in the spinal cord (its site of action), whereas intrathecally administered baclofen at 1/100th the dose results in cerebrospinal fluid levels comparable to serum levels following oral medications. Moreover, oral doses are associated with side-effects such as sedation, behavioural changes, confusion, ataxia, urinary frequency and insomnia. Hence, intrathecal delivery methods have been developed as an alternative to chronic systemic administration in an attempt to reduce pharmacological side effects such as physical tolerance, psychological dependency, and neurotoxicity. Intrathecal delivery of baclofen has been used to control spasticity in cases in which oral medications have failed to bring about the expected results. Unsuccessful treatment of spasticity and dystonia affects not only the patient, but also the caregivers, and increases the overall cost of the medical care. Continuous intrathecal baclofen (ITB) infusion has not been practised in any government hospitals in Malaysia. Therefore, there is a need to assess the feasibility of using continuous ITB infusion for treatment of patients with severe spasticity or severe dystonia or having both conditions who were uncontrolled by conventional treatment. This Health Technology Assessment (HTA) was requested by Rehabilitation Physicians, Hospital Raja Permaisuri Bainun, Ipoh, Perak.

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