From the Guidelines
Baclofen is a recommended treatment for post-stroke spasticity, with oral baclofen typically starting at 5mg three times daily and gradually increasing to 20-25mg three times daily as needed (maximum 80mg daily) 1. The oral form works by activating GABA-B receptors in the spinal cord, reducing muscle tone and painful spasms. For patients who don't respond adequately to oral baclofen or experience intolerable side effects, intrathecal baclofen delivered via an implanted pump may be considered. Some key points to consider when treating post-stroke spasticity with baclofen include:
- Treatment should be part of a comprehensive rehabilitation program including physical therapy to maintain range of motion and prevent contractures.
- Common side effects include drowsiness, weakness, and dizziness, which often improve with time.
- Patients should avoid abrupt discontinuation as this can cause withdrawal symptoms including hallucinations, seizures, and rebound spasticity.
- Regular follow-up appointments are important to assess effectiveness and adjust dosing.
- While baclofen helps manage symptoms, it doesn't address the underlying neurological damage from the stroke, so expectations should be realistic regarding recovery. It's also worth noting that evidence supports the use of botulinum toxin for patients with focal spasticity depending on patient characteristics and preferences, and that botulinum toxin may not have a dramatically different place in therapy from oral antispasmodics based on efficacy alone 1. However, the most recent and highest quality study recommends oral baclofen as a first-line treatment for post-stroke spasticity 1.
From the Research
Baclofen for Spasticity after Stroke
- Baclofen is a commonly used medication for managing spasticity, including in patients who have experienced a stroke 2.
- Oral baclofen may be effective in reducing spasticity in many patients, but it can also cause adverse effects such as muscle weakness, nausea, and somnolence, which can limit its usefulness 2.
- Intrathecal baclofen, which delivers the medication directly into the cerebrospinal fluid, may be a viable alternative for patients who experience intolerable side effects or do not respond to oral baclofen 2, 3.
Efficacy of Baclofen for Spasticity after Stroke
- A study found that intrathecal baclofen was associated with improvements in pain and quality of life in post-stroke patients with spasticity 3.
- Another study found that oral baclofen reduced spasticity in some patients with post-stroke spasticity, but the responder rate was low 4.
- The efficacy of baclofen for spasticity after stroke may vary depending on the individual patient and the severity of their spasticity 4.
Comparison with Other Treatments
- Botulinum toxin type A has been shown to be effective in reducing muscle tone and improving function in patients with post-stroke upper limb spasticity 5.
- A qualitative study found that patients with disabling spasticity after stroke experienced significant improvements in physical impairments and activities after treatment with botulinum toxin injections 6.
- The choice of treatment for spasticity after stroke may depend on the individual patient's needs and preferences, as well as the severity of their spasticity 6.
Patient-Centered Care
- Patients with spasticity after stroke may experience significant activity limitations and fluctuations in spasticity-related symptoms, which can impact their quality of life 6.
- Incorporating patient-relevant outcomes into the assessment of spasticity and monitoring these outcomes may help improve spasticity management and patient-centered care 6.
- Patient education and shared decision-making may also be important for optimizing treatment outcomes and improving patient satisfaction 6.