Intrathecal Baclofen Pump for Spasticity

Spasticity is a movement disorder that can occur in conditions which affect the brain or the spinal cord, such as multiple sclerosis, stroke, cerebral palsy, spinal cord injury, or brain injury. Spasticity is caused by an imbalance between signals that inhibit or stimulate the spinal cord. This results in hyperexcitable stretch reflexes, increased muscle tone, and involuntary movements. Baclofen is one of the medications most commonly used to treat spasticity. Baclofen acts in the spinal cord, and improves hyperactive reflexes and excessive muscle tone. Stopping baclofen suddenly may cause withdrawal symptoms that include seizures. ● An intrathecal delivery system, which provides the baclofen right to the target site in the spinal cord, is an effective way to deliver the medicine. ITB is usually much more effective in controlling the symptoms of spasticity, because the medication is brought directly in contact with the spinal cord. ● With ITB, the medication is delivered continuously, day and night, giving a more steady relief of symptoms. ● ITB, in most cases, causes less side effects than oral baclofen, particularly when high doses are needed to treat severe spasticity. ● ITB programming is very flexible, allows more precise dosing of baclofen, and gives the ability to deliver different doses at different times of the day. ● Compared to other surgical treatments, ITB is reversible, as the pump can be stopped and removed if needed The baclofen pump system needs to be surgically implanted under anesthesia, leading to the usual risks of surgery. Complications more specific to ITB include the risk of infection around the device, and the risk of device malfunction. Baclofen withdrawal (from abrupt interruption of the delivery of baclofen via the pump) and baclofen overdose (usually as a result of human error) have also occurred with ITB. Serious complications from ITB are infrequent, and in most cases reversible as long as they are diagnosed and treated in a timely fashion. Even without complications, ITB can cause increased weakness, because it is very potent.