Introduction This case report illustrates the effective use of a continuous subcutaneous infusion of baclofen to improve spasticity in a patient approaching end of life.
Report The patient was a 56 year old lady with a diagnosis of motor neurone disease (spinal onset; ‘definite’ by the El Escorial research criteria). She was admitted to the hospice for end of life care. She was severely dysarthric. She had a flicker of movement in her left hand, but no movement in her limbs otherwise. She communicated by nodding or shaking her head. She did not have a percutaneous endoscopic gastrostomy (PEG) tube in situ, and she was too frail for consideration of same. At the time of admission, she was taking baclofen 10 mg po tds for spasticity.
As she weakened, she couldn’t swallow her oral medications, necessitating discontinuation of her baclofen.
Three days later, she developed painful spasticity of her temporomandiibular joint muscles. She was very distressed by this symptom. It persisted over the following five days despite opioid analgesia and benzodiazepines. A literature review revealed a case report demonstrating the effective and well tolerated use of subcutaneous baclofen in a patient who could no longer take his medications via PEG.
A decision was made to commence a continuous subcutaneous infusion with bacofen 10 mg over 24 hours and NaCl as the diluent. The intrathecal formulation of baclofen was used.
The following day, the patient reported improvement in her spasticity, and she was able to open her mouth. The improvement was sustained over the following four days, and she experienced no skin reactions at the infusion site. At this time she could no longer communicate, and she was beginning to die. The baclofen was discontinued as she was no longer benefitting.
Conclusion This case illustrates the effective and well-tolerated administration of baclofen via subcutaneous infusion. If appropriate, we may consider this route again.