Intrathecal Baclofen for Spasticity — SCE Palliative Medicine MCQ

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HardNon-Malignant Palliative CareIntrathecal Baclofen for SpasticitySCE Palliative Medicine

A 65‑year‑old woman with advanced multiple sclerosis suffers severe spasticity with painful bilateral leg spasms. She is on oral baclofen 80 mg/day with only partial relief and remains significantly symptomatic. What is the most appropriate next escalation option?

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Correct answer: B — Intrathecal baclofen via an implanted pump delivering baclofen into the spinal fluid at much lower systemic doses

The correct answer is B. In MS‑related spasticity inadequately controlled by oral baclofen at 80 mg/day, referral for intrathecal baclofen (ITB) is the standard escalation in the UK. NICE NG220 recommends specialist referral for focal treatments including ITB when oral agents fail ([nice.org.uk](https://www.nice.org.uk/guidance/ng220/chapter/Recommendations?utm_source=openai)). A 2024 systematic review confirms ITB’s effectiveness in refractory MS spasticity with significant reduction of spasms and improved quality of life, with dosing in micrograms and mainly surgical complications ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/38823049/?utm_source=openai)). Increasing oral baclofen further (option E) raises toxicity risk without guaranteed benefit; oral dantrolene alone is inferior. IV baclofen is not a recognised route for long‑term management, and tendon‑release surgery is not appropriate as first escalation.

Reference: NICE NG220 (2022) Multiple sclerosis in adults: management; intrathecal baclofen recommendation. Systematic review (2024) on ITB effectiveness in refractory MS spasticity. https://www.nice.org.uk/guidance/ng220/chapter/Recommendations

Intrathecal Baclofen for Spasticity — SCE Palliative Medicine MCQ

A 65‑year‑old woman with advanced multiple sclerosis suffers severe spasticity with painful bilateral leg spasms. She is on oral baclofen 80 mg/day with only partial relief and remains significantly symptomatic. What is the most appropriate next escalation option?

A 65‑year‑old woman with advanced multiple sclerosis suffers severe spasticity with painful bilateral leg spasms. She is on oral baclofen 80 mg/day with only partial relief and remains significantly symptomatic. What is the most appropriate next escalation option?