Intrathecal clonidine may be an option for treating spasticity, especially for those HSPers where Baclofen has been found to cause too much weakness.
Spasticity and pain are common features of spinal cord disease that may be adequately treated with oral medications in many patients. However, for optimal results it is necessary to use intrathecal baclofen (ITB) or intrathecal morphine (ITM) delivered via a surgically implanted programmable pump in some patients. Most patients who need ITB/ITM therapy respond well but in some clinical situations there are problematic issues.
Our review shows that intrathecal clonidine (ITC) is well tolerated over a
prolonged period of time with 18 patients receiving ITC for 5 or more years and six patients for at least 10 years.
We conducted an IRB-approved retrospective chart analysis of all our patients on continuous ITC therapy. Our review showed that ITC was efficacious in the following circumstances:
(1) as a single agent for relief of spasticity in patients who had an unacceptable degree of weakness with the use of ITB
(2) as a single agent for relief of spasticity in patients who developed
tolerance to ITB after long-term use
(3) in patients with spasticity and significant weakness, addition of ITC to ITB enables a reduction in the dose of ITB necessary for spasticity relief, thereby decreasing the degree of weakness and optimizes functionality
(4) in combination with ITB in patients with spasticity who also had significant neuropathic pain syndrome and were intolerant to narcotics
(5) for relief of pain in patients with intractable pain and suboptimal responses to ITM or ITM/ITB therapy
SOURCE: J Neurol. 2012 May;259(5):982-4. Epub 2011 Nov 5.
Use of intrathecal clonidine in patients with multiple sclerosis or spastic paraparesis.
Ho JK1, Sadiq SA2
1Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles CA 90095-7403, USA.
2Multiple Sclerosis Research Center of New York, 521 W 57th Street, New York, NY 10019, USA