Multiple Sclerosis Clinical Services at the UCLH National Hospital
for Neurology and Neurosurgery, Queen Square.
The Spasticity Service and Intrathecal Baclofen Clinic
The service offers a comprehensive, responsive multidisciplinary service to patients
with spasticity associated with multiple sclerosis (MS). Therapies provided include
multidisciplinary assessments, video clinics, specialist physiotherapy, nurse-led
telephone clinics, botulinum toxin and intrathecal therapies.
Inpatient procedures including trials of both intrathecal phenol and baclofen take
place on the Neurorehabilitation Unit, as do implantation of intrathecal baclofen
pumps.
Occasionally an individuals' spasticity cannot be managed sufficiently despite
optimising posture, bladder, bowel and skin regimes, stretching and exercise regimes
and oral medication. In this situation an inpatient admission for further assessment is
recommended; during this admission trials of intrathecal medication may be
performed.
Baclofen is a common drug given to treat spasticity. Unfortunately when baclofen is
taken in tablet form it may cause side effects. In order to get the baclofen directly to
the spinal cord it can be delivered by an implantable pump. The pump is placed in
the abdomen and a catheter delivers the baclofen into the intrathecal space (the
space around the spinal cord within the spine). This method uses much smaller
amounts of baclofen to treat the spasticity, thus reducing any side effects.
If the trials show a beneficial response and the team and patient are in agreement,
then a baclofen pump will be fitted. It is important to remember that intrathecal
baclofen treatment requires commitment from individuals during the trial and
implant phase but also for its ongoing maintenance of regular refills and
replacements. Once a baclofen pump has been fitted, the patient will be regularly
followed up in the monthly Intrathecal Baclofen Refill Clinic.