Is the incidence of dementing illness changing? A 25‐year time trend study in Rochester, Minnesota (1960–1984)

Several issues relating to baclofen dosing and expected duration of therapeutic effect will need further study.It is possible that the test doses of intrathecal baclofen may be higher in stiffperson syndrome than in other conditions.In our patient, who experienced no adverse reactions to the initial testing, we do not know if a therapeutic response would have been obtained at baclofen doses higher than the standard test doses we administered.In general, we would advocate the use of blinded test-dose trials of intrathecal baclofen and placebo for each patient prior to pump placement.Because stiff-person syndrome is a rare entity, it may prove difficult to conduct a controlled, doubleblind, randomized trial of intrathecal baclofen with large numbers of patients.Thus, we may need to depend on isolated case reports employing this technique in order to define the longterm effectiveness of intrathecal baclofen in stiff-person syndrome as well as the ranges of expected benefit and toxicity.