Tolerance to intrathecal baclofen: clinical case report

Resumen

Introduction: Widespread severe spasticity, resulting from a lesion or central nervous system disorder, which remains unresponsive to maximal oral drug doses or other techniques, may warrant consideration of surgical implantation of an intrathecal baclofen infusion system. Materials and methods: This study entails a description of a clinical case along with a literature review. Results: We present the case of a 46-year-old patient treated with an intrathecal baclofen pump for widespread severe spasticity secondary to an incomplete spinal cord injury, classified as C3 AIS C. Due to suspected tolerance development, a gradual tapering of intrathecal baclofen was initiated until complete withdrawal. Subsequently, the patient underwent a three-week morphine sulfate infusion before baclofen reintroduction. Follow-up at one and four months revealed sustained clinical improvement in spasticity with low doses of intrathecal baclofen. Conclusion: The intrathecal baclofen pump ensures infusion of significantly lower baclofen quantities compared to oral ingestion. Catheter-related failure is the most common complication. However, in 5.9 % of prolonged treatment cases, a tolerance pattern has been documented, necessitating escalating intrathecal drug doses to sustain clinical efficacy. In such instances, a temporary cessation of baclofen, known as a “baclofen holiday”, may be considered.