Use of intrathecal clonidine in patients with multiple sclerosis or spastic paraparesis

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 [1–4]. Most patients who need ITB/ITM therapy respond well but in some clinical situations there are problematic issues, including: (1) Occasionally titration of ITB dose is difficult when relief of spasticity is associated with an unacceptable degree of muscle weakness; (2) Rarely patients on continuous long-term ITB therapy develop drug tolerance and cease to respond to escalating doses of ITB [5]; (3) Some patients with pain are intolerant to or rarely, inadequately responsive to intrathecal (IT) narcotics.

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