{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T03:06:59Z","timestamp":1788923219452,"version":"build-2803163510"},"reference-count":68,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The purpose of this systematic review was to evaluate empirical outcomes of studies in the literature that investigated effectiveness of intrathecal baclofen (ITB) in the treatment of multiple sclerosis (MS)\u2013related spasticity (MSRS) based on various metrics. Since the first description of this route of baclofen delivery for MS patients by Penn and Kroin in 1984, numerous studies have contributed to the medical community\u2019s knowledge of this treatment modality. The authors sought to add to the literature a systematic review of studies over the last 2 decades that elucidates the clinical impact of ITB in treating MSRS with the following endpoints: impact on patient-centered outcomes, such as spasticity reduction (primary), complications (secondary), and dosing (secondary).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors queried three databases (PubMed, Scopus, and Cochrane Library) using the following search terms: (intrathecal baclofen) AND (multiple sclerosis). The set inclusion criteria were as follows: 1) original, full-text article; 2) written in the English language; 3) published between and including the years 2000 and 2023; 4) discussion of pre- and post-ITB pump implantation outcomes (e.g., reduction in spasticity and improved comfort) in MSRS patients with long-term ITB treatment; and 5) contained a minimum of 5 MS patients. Data on study type, patient demographics, follow-up periods, primary outcomes, and secondary outcomes were extracted from the included studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The authors\u2019 search yielded 465 studies, of which 17 met inclusion criteria. Overall, they found evidence for the effectiveness of ITB in treating MSRS patients whose condition was refractory to oral medications, with significant reported changes in spasm frequency from pre- to postimplantation. They also found evidence supporting the positive impact of ITB on MSRS patients\u2019 quality of life. Moreover, the authors found that most complications were surgical rather than pharmacological. In addition, the average 1-year dose of ITB (reported in 7 of the included studies) was 191.93 \u03bcg\/day, which is substantially lower than ITB doses reported in the literature for patients with central (non-MS) or spinal origins of spasticity at 1-year follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The evidence supports ITB as a clinically effective treatment for MSRS, particularly in patients in whom oral antispasmodics and physiotherapy have failed. This systematic review contributes a comprehensive synthesis of clinical benefits, complications, and dosing of ITB reported over the past 2 decades, which furthers an understanding of ITB\u2019s clinical utility in practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.3.focus2464","type":"journal-article","created":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T05:41:48Z","timestamp":1717220508000},"page":"E14","source":"Crossref","is-referenced-by-count":7,"title":["Outcomes, complications, and dosing of intrathecal baclofen in the treatment of multiple sclerosis: a systematic review"],"prefix":"10.3171","volume":"56","author":[{"given":"Francesca M.","family":"Cozzi","sequence":"first","affiliation":[{"name":"Cambridge Brain Tumour Imaging Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke\u2019s Hospital, University of Cambridge, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Zuckerman","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel","family":"Sacknovitz","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nimrod","family":"Gozum","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun","family":"Syal","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Danisi","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla, New York;"},{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishad","family":"Sukul","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla, New York;"},{"name":"Neurosurgery, Westchester Medical Center, Valhalla, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"8385","key":"b1","series-title":"Lancet","first-page":"1078","article-title":"Intrathecal baclofen alleviates spinal cord spasticity","volume":"1","author":"Penn RD","year":"1984","unstructured":"Penn RD, Kroin JS. Intrathecal baclofen alleviates spinal cord spasticity. Lancet. 1984;1(8385):1078."},{"key":"b2","first-page":"181","article-title":"Intrathecal baclofen for the control of spinal and supraspinal spasticity","author":"Rushton DN","year":"2008","unstructured":"Rushton DN. Intrathecal baclofen for the control of spinal and supraspinal spasticity In: Barnes MP, Johnson GR, eds. Upper Motor Neurone Syndrome and Spasticity: Clinical Management and Neurophysiology. 2nd ed. Cambridge University Press; 2008:181-192."},{"issue":"5","key":"b3","series-title":"Mult Scler","first-page":"623","article-title":"Intrathecal baclofen in multiple sclerosis: too little, too late?","volume":"17","author":"Erwin A","year":"2011","unstructured":"Erwin A, Gudesblatt M, Bethoux F,  Intrathecal baclofen in multiple sclerosis: too little, too late? Mult Scler. 2011;17(5):623\u2013629."},{"issue":"6","key":"b4","series-title":"PM R","first-page":"553","article-title":"Intrathecal versus oral baclofen: a matched cohort study of spasticity, pain, sleep, fatigue, and quality of life","volume":"8","author":"McCormick ZL","year":"2016","unstructured":"McCormick ZL, Chu SK, Binler D,  Intrathecal versus oral baclofen: a matched cohort study of spasticity, pain, sleep, fatigue, and quality of life. PM R. 2016;8(6):553\u2013562."},{"issue":"71","key":"b5","series-title":"BMJ","first-page":"n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page MJ","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM,  The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71):n71."},{"issue":"6","key":"b6","series-title":"Mult Scler","first-page":"933","article-title":"Long-term outcomes of intrathecal baclofen in ambulatory multiple sclerosis patients: a single-center experience","volume":"27","author":"Abbatemarco JR","year":"2021","unstructured":"Abbatemarco JR, Griffin A, Jones NG,  Long-term outcomes of intrathecal baclofen in ambulatory multiple sclerosis patients: a single-center experience. Mult Scler. 2021;27(6):933\u2013941."},{"issue":"2","key":"b7","series-title":"Neuromodulation","first-page":"75","article-title":"Intrathecal baclofen for the treatment of intractable spasticity of spine or brain etiology","volume":"3","author":"Avellino AM","year":"2000","unstructured":"Avellino AM, Loeser JD. Intrathecal baclofen for the treatment of intractable spasticity of spine or brain etiology. Neuromodulation. 2000;3(2):75\u201381."},{"issue":"1","key":"b8","series-title":"Mult Scler","first-page":"101","article-title":"Intrathecal baclofen for treatment of spasticity of multiple sclerosis patients","volume":"12","author":"Ben Smail D","year":"2006","unstructured":"Ben Smail D, Peskine A, Roche N, Mailhan L, Thi\u00e9baut I, Bussel B. Intrathecal baclofen for treatment of spasticity of multiple sclerosis patients. Mult Scler. 2006;12(1):101\u2013103."},{"issue":"4","key":"b9","series-title":"Clin Neurol Neurosurg","first-page":"289","article-title":"Functional outcome of intrathecal baclofen administration for severe spasticity","volume":"107","author":"Boviatsis EJ","year":"2005","unstructured":"Boviatsis EJ, Kouyialis AT, Korfias S, Sakas DE. Functional outcome of intrathecal baclofen administration for severe spasticity. 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J Med Liban. 2004;52(1):13\u201318."},{"key":"b12","series-title":"Mult Scler Relat Disord","first-page":"102831","article-title":"Evaluation of the cognitive benefits of intrathecal baclofen pump implantation in people with intractable multiple sclerosis related spasticity","volume":"50","author":"Farrell R","year":"2021","unstructured":"Farrell R, Summers M, Doogan C,  Evaluation of the cognitive benefits of intrathecal baclofen pump implantation in people with intractable multiple sclerosis related spasticity. Mult Scler Relat Disord. 2021;50:102831."},{"issue":"2","key":"b13","series-title":"NeuroRehabilitation","first-page":"117","article-title":"Clinical outcome and complications of intrathecal baclofen pump in multiple sclerosis patients: a retrospective study","volume":"27","author":"Khan AA","year":"2010","unstructured":"Khan AA, Birks-Agnew I, Bullock P, Rushton D. Clinical outcome and complications of intrathecal baclofen pump in multiple sclerosis patients: a retrospective study. NeuroRehabilitation. 2010;27(2):117\u2013120."},{"issue":"4","key":"b14","series-title":"J Neurosurg","first-page":"1056","article-title":"Early outcomes after intrathecal baclofen therapy in ambulatory patients with multiple sclerosis","volume":"129","author":"Lee BS","year":"2018","unstructured":"Lee BS, Jones J, Lang M,  Early outcomes after intrathecal baclofen therapy in ambulatory patients with multiple sclerosis. J Neurosurg. 2018;129(4):1056\u20131062."},{"key":"b15","series-title":"Clin Neurol Neurosurg","first-page":"121","article-title":"Long-term effects of intrathecal baclofen in multiple sclerosis","volume":"143","author":"Natale M","year":"2016","unstructured":"Natale M, D\u2019Oria S, Nero VV, Squillante E, Gentile M, Rotondo M. Long-term effects of intrathecal baclofen in multiple sclerosis. 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Neurology. 2005;64(6):1086\u20131087."},{"issue":"11","key":"b20","series-title":"Vojnosanit Pregl","first-page":"1076","article-title":"Continuous intrathecal baclofen delivery in severely disabling spasticity","volume":"75","author":"Simsek H","year":"2018","unstructured":"Simsek H, Zorlu E, Bakal O, Akarsu S, G\u00fcney S. Continuous intrathecal baclofen delivery in severely disabling spasticity. Vojnosanit Pregl. 2018;75(11):1076\u20131082."},{"issue":"4","key":"b21","series-title":"NeuroRehabilitation","first-page":"385","article-title":"Effects of severe spasticity treatment with intrathecal Baclofen in multiple sclerosis patients: long term follow-up","volume":"38","author":"Stampacchia G","year":"2016","unstructured":"Stampacchia G, Gerini A, Mazzoleni S. Effects of severe spasticity treatment with intrathecal Baclofen in multiple sclerosis patients: long term follow-up. 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Mult Scler. 2004;10(5):589\u2013595."},{"issue":"3","key":"b32","series-title":"J Rehabil Med","first-page":"193","article-title":"Efficacy and safety of oral baclofen in the management of spasticity: a rationale for intrathecal baclofen","volume":"49","author":"Ertzgaard P","year":"2017","unstructured":"Ertzgaard P, Campo C, Calabrese A. Efficacy and safety of oral baclofen in the management of spasticity: a rationale for intrathecal baclofen. J Rehabil Med. 2017;49(3):193\u2013203."},{"key":"b33","series-title":"J Spinal Cord Med","article-title":"Dose escalation in intrathecal baclofen therapy based on disease etiology: can an a priori target dose be established? A ten-year follow-up study","author":"G\u00fcnd\u00fcz ME","unstructured":"G\u00fcnd\u00fcz ME, Haak F, Visser-Vandewalle V, Matis G. Dose escalation in intrathecal baclofen therapy based on disease etiology: can an a priori target dose be established? A ten-year follow-up study. J Spinal Cord Med. Published online November 20, 2023. doi:10.1080\/10790268.2023.2266614"},{"issue":"1","key":"b34","series-title":"Arch Phys Med Rehabil","first-page":"119","article-title":"Intrathecal and oral baclofen use in adults with spinal cord injury: a systematic review of efficacy in spasticity reduction, functional changes, dosing, and adverse events","volume":"104","author":"Dietz N","year":"2023","unstructured":"Dietz N, Wagers S, Harkema SJ, D\u2019Amico JM. Intrathecal and oral baclofen use in adults with spinal cord injury: a systematic review of efficacy in spasticity reduction, functional changes, dosing, and adverse events. Arch Phys Med Rehabil. 2023;104(1):119\u2013131."},{"issue":"8385","key":"b1","series-title":"Lancet","first-page":"1078","article-title":"Intrathecal baclofen alleviates spinal cord spasticity","volume":"1","author":"Penn RD","year":"1984","unstructured":"Penn RD, Kroin JS. Intrathecal baclofen alleviates spinal cord spasticity. 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Neuromodulation. 2000;3(2):75\u201381."},{"issue":"1","key":"b8","series-title":"Mult Scler","first-page":"101","article-title":"Intrathecal baclofen for treatment of spasticity of multiple sclerosis patients","volume":"12","author":"Ben Smail D","year":"2006","unstructured":"Ben Smail D, Peskine A, Roche N, Mailhan L, Thi\u00e9baut I, Bussel B. Intrathecal baclofen for treatment of spasticity of multiple sclerosis patients. Mult Scler. 2006;12(1):101\u2013103."},{"issue":"4","key":"b9","series-title":"Clin Neurol Neurosurg","first-page":"289","article-title":"Functional outcome of intrathecal baclofen administration for severe spasticity","volume":"107","author":"Boviatsis EJ","year":"2005","unstructured":"Boviatsis EJ, Kouyialis AT, Korfias S, Sakas DE. Functional outcome of intrathecal baclofen administration for severe spasticity. 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J Med Liban. 2004;52(1):13\u201318."},{"key":"b12","series-title":"Mult Scler Relat Disord","first-page":"102831","article-title":"Evaluation of the cognitive benefits of intrathecal baclofen pump implantation in people with intractable multiple sclerosis related spasticity","volume":"50","author":"Farrell R","year":"2021","unstructured":"Farrell R, Summers M, Doogan C,  Evaluation of the cognitive benefits of intrathecal baclofen pump implantation in people with intractable multiple sclerosis related spasticity. Mult Scler Relat Disord. 2021;50:102831."},{"issue":"2","key":"b13","series-title":"NeuroRehabilitation","first-page":"117","article-title":"Clinical outcome and complications of intrathecal baclofen pump in multiple sclerosis patients: a retrospective study","volume":"27","author":"Khan AA","year":"2010","unstructured":"Khan AA, Birks-Agnew I, Bullock P, Rushton D. Clinical outcome and complications of intrathecal baclofen pump in multiple sclerosis patients: a retrospective study. NeuroRehabilitation. 2010;27(2):117\u2013120."},{"issue":"4","key":"b14","series-title":"J Neurosurg","first-page":"1056","article-title":"Early outcomes after intrathecal baclofen therapy in ambulatory patients with multiple sclerosis","volume":"129","author":"Lee BS","year":"2018","unstructured":"Lee BS, Jones J, Lang M,  Early outcomes after intrathecal baclofen therapy in ambulatory patients with multiple sclerosis. J Neurosurg. 2018;129(4):1056\u20131062."},{"key":"b15","series-title":"Clin Neurol Neurosurg","first-page":"121","article-title":"Long-term effects of intrathecal baclofen in multiple sclerosis","volume":"143","author":"Natale M","year":"2016","unstructured":"Natale M, D\u2019Oria S, Nero VV, Squillante E, Gentile M, Rotondo M. Long-term effects of intrathecal baclofen in multiple sclerosis. 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