Tolerance to continuous intrathecal baclofen infusion can be reversed by pulsatile bolus infusion.

STUDY
DESIGN: Pilot study.
OBJECTIVE: To study the effect of pulsatile bolus infusion of intrathecal baclofen (ITB) on daily ITB dose, in patients showing dose increases, probably due to tolerance.
SETTING: Department of neurology and neurosurgery, University Medical Center Groningen, the Netherlands.
METHODS: Data on dosages and clinical efficacy were gathered from four patients who were switched from continuous to pulsatile bolus infusion of ITB, because of the probable diagnosis of tolerance to ITB.
RESULTS: Switching from continuous to pulsatile bolus infusion resulted in a decrease of the daily ITB dose, while the clinical effect could be kept stable, without introducing adverse events.
CONCLUSION: Pulsatile bolus infusion of ITB seems to be an effective and safe treatment strategy to reverse the need for increasing ITB dosages in patients with the probable diagnosis of tolerance to ITB.