Baclofen Boluses Via Lumbar Puncture for Diagnosing Loss of Intrathecal Baclofen Efficacy: A Case Series.

LP-delivered boluses should be considered after initial LOE workup for disease progression and medical triggers is negative and when changes in pump settings - including boluses - produce no improvement. The initial steps for evaluating loss of efficacy (LOE) of intrathecal baclofen (ITB) therapy include ruling out medical triggers and disease progression, followed by noninvasive and invasive testing to identify pump/catheter malfunction.1 As a last step, consensus guidelines mention using an ITB bolus delivered via lumbar puncture (LP).1 If spasticity improves with a LP-delivered bolus and not with changes in the pump settings, it suggests pump/catheter malfunction.1,2 There is little research evaluating the utility of this technique. [Extracted from the article]