To Kalyvas et al., knowledge, this is the third reported case in the literature. Unfortunately, the pathophysiological characteristics of muscle spasms in FA are not well explored and understood while the therapeutic mechanisms of the different treatments are rather vague. Taking into consideration the suggested spinal atrophy in FA, the clinical resemblance of FA and chronic spinal injury muscle spasms, together with the rapid ITB therapy effectiveness in alleviating FA muscle spasms, they attempted to suggest a putative pathophysiological mechanism acting at the spinal level and possibly explained by the presence of independent spinal locomotor systems producing muscle spasms. Specifically, overexcitement of these centers, due to loss of normal regulation from upper CNS levels, may result in the uncontrolled firing of secondary motor neurons and may be the key to producing muscle spasms. However, further research under experimental and clinical settings seems to be necessary 1).
A 50-year-old female patient with Friedreich ataxia (FA) was treated successfully with an intrathecal baclofen (ITB)-delivering pump for painful spasms. This is the second reported case of FA where ITB relieved painful and disabling spasms. Berntsson et al., suggest that ITB should be considered in the treatment of disabling spasms in patients with FA 2).
Ben Smail et al.,reported a patient suffering from Friedreich's ataxia (FA) with very painful and disabling spasms that were improved markedly by intrathecal baclofen infusion. This is the first report of an intrathecal baclofen-delivering pump implantation in an FA patient 3).