The Role of Ziconotide in the Reduction of Spasticity: A Case Report
Ziconotide, sold under the label Prialt®, is an non-opioid analgesic N-type calcium blocker that is approved for the treatment of chronic pain when delivered by way of intrathecal infusion. Due to its expense and that it can only be delivered intrathecally, the drug is approved for the management of severe chronic pain in patients for whom intrathecal therapy is warranted and who are intolerant of or refractory to other treatments. Although most intrathecal pump systems are approved primarily for monotherapy, ziconotide is often used adjunctly with other intrathecal drugs, primarily opioids and, in patients with spasticity, baclofen. There is limited evidence that ziconotide may potentiate the effects of opioids and baclofen and result in increased pain relief and increased spasticity relief respectively. Other reports have shown some anecdotal evidence that ziconotide may help to treat spasticity, with Ridgeway et al reporting 2 cases where ziconotide therapy alone resulted in dramatic spasticity relief for patients with spinal cord injury. The objective of this study is to add to the discussion a case study where intrathecal ziconotide may have provided a patient with dramatic spasticity relief when used in conjunction with baclofen.