Spasticity is an increase in muscle tone that can cause pain, deformity and limited function, and which occurs as a consequence of central nervous system disorders including multiple sclerosis, stroke, spinal cord injury, traumatic brain injury, cerebral palsy, and motor neuron (Lou Gehrig’s) disease.
The Intrathecal Baclofen (ITB) Program is one integral component of our Comprehensive Spasticty and Dystonia Center at Monmouth Neuroscience Institute. ITB therapy uses an implanted battery powered programmable pump to deliver medication directly on to the spinal cord, relieving spasticity that did not respond to oral medications.
The test dose – are you a candidate? One important benefit of ITB therapy is that you can try it first during a screening test before you commit to placement of a permanent pump for long-term therapy. This is an opportunity to see how your body will react to the medication, and your experience during the screening test will be used by you and your doctors to decide if long-term therapy is right for you. The screening test is performed as an outpatient in the “day stay” unit at the hospital. Once you come to the hospital, and have been evaluated by the nurse and physical therapist, the doctor will perform a lumbar puncture (spinal tap) and inject a single small test dose of the medication directly into the spinal canal. The medication may take 30 to 60 mins to begin to relax your muscles, and has a peak effect at about 4 hours after the injection. During this time you will be carefully monitored, and undergo repeated examinations to look for a benefit in terms of reduced muscle tone, increased flexibility, and change in function (for example ability to transfer and walk). After your screening test(s) have been completed, you will discuss your results with your physician, and determine if you might be a candidate for long term ITB therapy through an implanted pump. Click here for an example video of a patient who improved with a test dose of ITB.
The intrathecal baclofen pump: If your screening test is successful, you and your doctor will likely decide to pursue long term ITB therapy, and the next step would be to implant the permanent infusion system pump and catheter. This is accomplished with a surgical procedure performed under general anesthesia that takes 1-3 hours and may require overnight hospitalization. You and your physician will be able adjust the pump using an external programming device to optimally manage your spasticity by delivering the appropriate dose of medication. It may take several weeks or months to reach the optimal dose. Some patients are sent for a brief period of inpatient rehabilitation including intense physical and occupational therapy and ongoing pump titration to help them better adapt to changes in function resulting from reduced spasticity.
Long term follow-up: Once you have an ITB pump placed, it’s important to make regular return visits to your doctor or clinic to ensure appropriate ongoing therapy. The dose of medication delivered into your spine may need to be adjusted based on your symptoms and response to treatment. The pump will need to be refilled regularly on schedule – your pump should not be allowed to run out of medication. Your doctor will educate you about other symptoms to watch out for that could indicate one of these complications, and our team will be available to help you should this occur. Click here for more information about when to suspect a problem and what to do about it.