How is intrathecal Baclofen given?
Baclofen is a medicine that is used to lessen spasticity. With the intrathecal method of using Baclofen, a surgeon places a pump into a child’s abdomen. The pump sends Baclofen into the area around the spinal cord, called the intrathecal space. Because Baclofen works mainly in the spinal cord, it can have a large effect on spasticity. The pump is programmed to deliver a specific dose of medicine to your child. An external computer can adjust the rate of the pump based on your child’s needs.
What are the benefits of intrathecal Baclofen?
Intrathecal Baclofen often drastically reduces spasticity. Therefore, it may have major benefits in children with severe spasticity in many parts of their body. These benefits include: lessening pain, improving the ease of caring for the child and preventing a deformity. The greatest effect of intrathecal Baclofen is usually in the legs. Intrathecal Baclofen may lead to improved walking skills, hand function and speech. The pump rate can be adjusted to decrease spasticity, yet keep some underlying strength in your child’s muscles.
How is intrathecal Baclofen given?
To help decide whether a child would benefit from an intrathecal Baclofen pump a test dose is given during a one-day trial. This is done with a small needle that is placed into the spinal column in the lower back. Your child must stay very still for this procedure. A special cream called EMLA may be used to numb the area where the needle is placed. This area may also be numbed with a medicine called Xylocaine®. It may sting when placed underneath the skin. Sometimes this is not necessary if the numbing cream does a good job of numbing the area. During the one-day trial, your child is monitored at Oakwood Hospital & Medical Center for changes in spasticity and function.
If the family, patient, therapists, and doctor agree that the intrathecal Baclofen test dose worked well, a refillable, programmable Baclofen pump may be placed to deliver the medicine during surgery. The pump is about the size of a hockey puck and is placed under the skin of the belly, above the waistline. Tubing (called a catheter) is connected to the pump and travels under the skin to the intrathecal space in the back. The usual hospital stay for placing a pump is four to five days.
What are the potential risks and side affects of intrathecal Baclofen?
In any surgery, there is a risk of infection and bleeding. The tubing may break or kink. Surgery would be needed to repair this problem. If the pump is not refilled when needed, your child may experience symptoms of Baclofen withdrawal, including high levels of spasticity, agitation, itching, and in severe cases, seizures. Occasionally, in patients who are unable to walk and who have scoliosis, the lessened control over the upper torso may lead to worsening of scoliosis.
How is the pump managed after surgery?
- At follow-up appointments, a doctor or nurse reviews how the pump is working. The pump is programmed with a computer that acts like a remote control. The rate at which the medicine is released can be increased or decreased according to your child’s needs. Usually, the rate is gradually increased for several months after surgery to reach the optimal level of spasticity control.
- The Baclofen pump needs to be refilled every two to four months. Prior to coming to the clinic for refilling, the parent places EMLA cream over the pump site to numb the skin. At the clinic, the physician or nurse inserts a needle through the skin into the pump to refill it.
- The pump battery lasts for six to seven years, depending on the dosage. Before the battery runs out, the pump must be surgically replaced.