Do I need a Pump for Intrathecal Baclofen?

A typical medication for reducing spasticity brought on by multiple sclerosis, spinal cord injuries, or other neurological conditions is baclofen, a muscle relaxant. An efficient medication method is via an intrathecal delivery device, which delivers the baclofen directly to the spinal cord’s target region.

Outline

Spasticity: What is it?

Spasticity is a movement issue that can develop in diseases including multiple sclerosis, stroke, cerebral palsy, spinal cord injury, or brain damage that affects the brain or spinal cord. An imbalance between messages stimulating or inhibiting the spinal cord results in spasticity. Stretch reflexes that are overly excited cause tighter muscles and uncontrollable motions.

What signs of spasticity are there?

Muscle rigidity and stiffness brought on by spasticity prevent people from moving freely. Muscle spasms (jerky involuntary movements) or clonus can also be brought on by spasticity (repetitive, automatic movement). Spasms and stiffness can be uncomfortable and bothersome, making it difficult to go about your everyday activities. Additionally, spasms may cause sleep disruption and worsen daytime weariness. Contractures (fixed range of motion restrictions) may form due to severe spasticity.

How is spasticity treated?

The primary treatments for spasticity are stretching, exercise, and rehabilitation. Although sleepiness is a potential adverse effect of oral medicines, they are frequently beneficial. Local injections of botulinum toxin may be beneficial when spasticity only affects a few muscles. Intrathecal baclofen (Lioresal®) (ITB) may be an effective therapy choice for diffuse and severe spasticity.

Defining baclofen

One of the drugs that are most frequently used to treat spasticity is baclofen. The spinal cord is where baclofen works to reduce overactive reflexes and excessive muscular tone. The following are a few baclofen adverse effects:

  • Drowsiness
  • Dizziness
  • Weakness
  • Nausea
  • Headache

Seizures are among the withdrawal symptoms that may occur if baclofen is abruptly stopped. Avoid quitting this drug all at once.

How can I tell whether I’d be a good ITB candidate?

If oral drugs are ineffective for treating your severe spasticity, your treating doctor may recommend a consultation to see whether ITB would be an appropriate choice for you. Physical/occupational therapists and doctors often do thorough clinical evaluations. For debate, these experts present knowledge about ITB.

The next step is to provide a test injection to assess if ITB is necessary. A spinal tap is used for the test, after which a small amount of baclofen is administered into the spinal fluid. The medication’s effects are assessed a few hours later. Although these impacts only last a short while, they offer valuable information that aids decision-making.

What occurs if the test is effective?

If the test is successful, your medical provider will refer you to a neurosurgeon who will implant the baclofen pump system. You’ll spend a brief time in the hospital following the procedure. Before going home, it may be necessary to modify the pump and complete functional training while receiving inpatient rehabilitation. To maximize ITB’s advantages: outpatient or at-home rehabilitation is required in all circumstances.

Procedure information

What is baclofen intrathecal therapy?

Baclofen is often ingested multiple times daily. Using a device known as a baclofen pump, intrathecal baclofen treatment (ITB) involves injecting a liquid version of baclofen into the spinal fluid. For the treatment of severe spasticity, ITB has FDA approval. What is a baclofen pump? ITB has been utilized at the Mellen Center since 1990.

What is a baclofen pump?

A catheter transfers the medicine from the baclofen pump into the spinal fluid. The pump is a circular metallic disc that is surgically placed beneath the skin of the abdomen. It is approximately 1 inch thick and 3 inches in diameter.

The pump is equipped with a microprocessor, a reservoir for the medicine, and a battery that typically lasts between 5 and 7 years. A tiny computer that can interface with the pump through a wand held over the skin can program the pump. A small, flexible tube called a catheter is inserted beneath the skin. The catheter’s other end is placed into the spine at various levels, with one end attached to the pump and the other to the catheter.

What does the maintenance of a baclofen pump entail?

Regular refills of the pump are required (often every 1 to 6 months) by a qualified healthcare provider with the required tools. The refill port on the pump is accessed by putting a needle through the skin. Refills may be completed at home in certain situations, but follow-up visits are required once or twice a year to ensure the therapy is effective. Baclofen dosage adjustments can be made whenever necessary, but only by qualified medical personnel. The pump must be changed as the battery nears the end of its useful life (but not the catheter). It is essential to seek medical assistance immediately if a baclofen pump issue is detected.

Risk & Advantages

What benefits does ITB provide over oral baclofen administration?

  • Due to the medication’s direct interaction with the spinal cord, ITB is often far more successful at reducing the symptoms of spasticity.
  • With ITB, the drug is constantly administered, day and night, providing more consistent symptom alleviation.
  • When high dosages of ITB are required to treat severe spasticity, it often has fewer adverse effects than oral baclofen.
  • ITB programming is more versatile, enables more accurate baclofen dosage, and enables the delivery of various doses at various times throughout the day.
  • ITB is reversible compared to other surgical procedures since the pump may be turned off and withdrawn if necessary.

What are ITB’s possible dangers and adverse effects?

The baclofen pump system must be inserted surgically under anesthesia, which entails the standard hazards of surgery.

The danger of infection near the device and the chance of device failure are complications more unique to ITB. ITB has also been associated with baclofen withdrawal (caused by a sudden halt in the pump’s supply of baclofen) and baclofen overdose (often due to human error). As long as they are identified and treated promptly, serious ITB consequences are uncommon and often treatable. ITB is so powerful that it can exacerbate weakness even without problems.

ADDITIONAL INFORMATION

Does insurance cover ITB treatment?

ITB is frequently covered by medical insurance, such as Medicare and Medicaid because it has FDA approval. We advise you to call your insurance company in advance because coverage varies widely across different insurance plans.

To sum up:

  • When treating severe spasticity, ITB can significantly enhance the quality of life.
  • Before beginning this therapy, extensive testing and instruction are required because ITB is a surgical procedure with known hazards.
  • To increase the odds of success and reduce the risk of negative effects or problems, compliance with follow-up appointments, rehabilitation, and home exercise is crucial.

References:

https://www.ninds.nih.gov/health-information/disorders/spasticity#:~:text=Spasticity%20is%20a%20condition%20in,cord%20that%20control%20muscle%20movement.