Targeted drug delivery
Severe spasticity
Patient selection and treatment goals
Helping patients reduce severe spasticity with Targeted Drug Delivery (TDD)
Using Targeted Drug Delivery can significantly decrease severe spasticity2,9,12 and spasms.3,7–9 TDD provides provides long-term relief of severe spasticity symptoms with far less baclofen than oral doses.3–5,10 Less medication may help minimize some of the possible side effects that may accompany oral baclofen.3–5,10
SynchroMed™ III implantable infusion system
The SynchroMed™ III implantable infusion system delivers baclofen directly into the intrathecal space, thereby bypassing the blood-brain barrier. As a result, only a fraction of the oral dose is needed to produce efficacy while minimizing systemic side effects.11
Clinical outcomes
In clinical studies, the test dose of TDD for severe spasticity was effective for:
Patient selection: Targeted Drug Delivery for severe spasticity
The 2005 SPASM consortium defined severe spasticity as troublesome, problematic spasticity for patients and caregivers.12 TDD for severe spasticity should be considered for:
- Patients who are unresponsive to oral baclofen or who experience intolerable central nervous system (CNS) side effects from oral baclofen
- Spasticity that interferes with function or daily activities14
- Spasticity that interferes with care or positioning14
- Spasticity-related pain14
Key considerations for patient selection14
- TDD for severe spasticity can be an effective tool in improving ambulatory function in certain patients. Rehabilitative therapy should be applied concomitantly in ambulatory patients.
- TDD for severe spasticity is a highly effective tool for spasticity reduction in the pediatric population. The unique characteristics of this group require specialized attention, including baseline evaluations for scoliosis, hip status, hydrocephalus, and urodynamic status.
- While not a directly disease-modifying treatment, TDD for severe spasticity should be considered early to potentially avoid or delay musculoskeletal and functional consequences of spasticity.
- Safety and effectiveness in pediatric patients below the age of four has not been established.
- This therapy is not for everyone. Results vary. Not every individual will receive the same benefits or experience the same complications.
- TDD for severe spasticity must always be considered in the context of other factors affecting patients with spasticity, with cognitive ability being of paramount significance.
Therapy education and treatment goals for severe spasticity patients14
- Patient/family/caregiver education is a crucial process in TDD for severe spasticity. Centers must create a supportive instructive environment that uses all available resources to accomplish the education goals effectively.
- Goal setting is necessary for patients and clinicians to approach the usage of TDD for severe spasticity in a meaningful and effective way.
- Clinicians must consider the absolute and relative contraindications for TDD for severe spasticity and, if needed, develop appropriate strategies for addressing these issues.
- Relative contraindications include unrealistic goals, unmanageable mental health issues, psychosocial factors affecting compliance, and financial burden.
