Intrathecal baclofen therapy (IBT) can markedly improve comfort and quality of life. It also improves the functioning of children with severe spasticity or secondary dystonia, particularly affecting the upper and lower body. In this therapy, a pump delivers baclofen medication directly into the cerebrospinal fluid (CSF) in the spine (intrathecally) to relax muscle movement. The pump is surgically implanted in the abdomen, requiring a refill at an outpatient clinic every 2-6 months, and a battery change every seven years (surgically).
What is it?
Spasticity occurs in conjunction with some disorders affecting the brain or spinal cord, such as multiple sclerosis or cerebral palsy. Spasticity involves muscle tightness, stiffness, and spasms, which are very disruptive to a patient’s daily functioning and quality of life. For severe spasticity proving to be unresponsive to treatments like stretching or injections, IBT may be the appropriate course of treatment. As opposed to taking baclofen medication by mouth, a baclofen pump is used in IBT, administering medication directly and continuously into the spinal cord. This has several advantages, such as flexibility, control, and reversibility.
What should I do to prepare?
Usually, the patient will want to meet with a doctor to determine whether or not IBT is necessary to alleviate the patient’s symptoms. After a few consultations, patients will undergo a minimally invasive surgery to implant the pump. The patient is advised not to eat or drink anything after midnight, in the night prior to the surgery. Overall health will help determine recovery time from the implantation surgery, so patients are encouraged to practice a healthy diet, exercise, and manage digestive health in anticipation of the procedure.
What happens during the process?
A surgeon will mark the incision site on the abdomen. The patient will then undergo general anesthesia, either from a gas mask or IV sedation. Once asleep, IV fluids will be administered, and a breathing tube will be installed. A surgeon fills a small pump with baclofen and implants it under the skin of the abdomen, just above the waistline. A catheter is then threaded under the skin from the pump to the intrathecal space surrounding the spinal cord, where the medication is delivered. The surgeon closes the incision site with stitches, and the procedure is concluded.
What are the risks and potential complications?
There are potential side effects and risks with IBT, namely due to the implantation surgery and with the baclofen medication itself. These risks include:
- Infection around the area of device
- Device malfunction
- Baclofen withdrawal
- Baclofen overdose
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