From the Guidelines
The recommended dose of baclofen for managing spasticity in patients with Traumatic Brain Injury (TBI) is typically 30 to 80 mg per day, in multiple doses titrated to effect and tolerance, as supported by the most recent study 1. This dose range is based on a small RCT that compared the efficacy of botulinum toxin versus oral baclofen on multiple upper- and lower-limb spasticity outcomes, including the Modified Ashworth Scale and Brunnstrom Stages of Stroke Recovery. Some key points to consider when prescribing baclofen for TBI patients include:
- Starting with a low dose and titrating slowly to minimize side effects such as drowsiness, dizziness, weakness, and confusion
- Gradually increasing the dose by 5 mg per dose every 3 days until the desired therapeutic effect is achieved
- Regular monitoring for efficacy and side effects, and individualizing the dose based on patient response
- Avoiding abrupt discontinuation, which may cause hallucinations, anxiety, tachycardia, and increased spasticity, and instead tapering the medication gradually over 1-2 weeks when discontinuing
- Considering dose adjustments cautiously in elderly patients and those with renal impairment. It's also important to note that while the study 1 provides guidance on the dose range, the optimal dose for individual patients may vary, and careful monitoring and adjustment are necessary to achieve the best outcomes.
From the Research
Baclofen for TBI Spasticity Dose
- The recommended dose of baclofen for managing spasticity in patients with Traumatic Brain Injury (TBI) is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, baclofen is mentioned as a treatment option for spasticity in TBI patients in several studies 2, 3, 5.
- The study by 2 mentions that baclofen and tizanidine were tested in some studies, but the results were not reported adequately.
- Another study 6 compares botulinum neurotoxin with tizanidine in upper limb spasticity, but does not provide information on baclofen dosing.
- The management of spasticity in TBI patients often involves a combination of pharmacological and non-pharmacological interventions, and the dosage of baclofen may vary depending on the individual patient's needs and response to treatment 2, 3, 4, 5.
Limitations of Current Evidence
- The current evidence on the management of spasticity in TBI patients is limited by poor reporting, small study size, and heterogeneity of interventions and comparator groups 2.
- There is a need for well-designed and adequately powered studies to evaluate the effectiveness and safety of different treatments, including baclofen, for spasticity in TBI patients 2, 5.
- The development of clinical practice guidelines specific to TBI-related spasticity is also necessary to provide clinicians with evidence-based recommendations for treatment 5.