Managing loss of intrathecal baclofen efficacy: Review of the literature and proposed troubleshooting algorithm

Spasticity is a debilitating symptom associated with numerous neurologic conditions. While intrathecal baclofen therapy (ITB) is an established treatment for spasticity, complications can lead to loss of efficacy (LOE) and baclofen withdrawal. Untreated withdrawal syndrome can be fatal. Prompt diagnosis and management of LOE is essential. Numerous methods have been described in the literature for diagnosing the cause of LOE. Many of the methods require equipment not readily available in the outpatient setting. Furthermore, there is no established consensus on the sequencing of these diagnostic tests. Herein, we review ITB literature on troubleshooting LOE for applicability to the managing clinician. Using this information and our clinical experience, we propose an algorithm with management recommendations to simplify and expedite the troubleshooting process in the outpatient setting.