Rehabilitation Services
Intrathecal Baclofen Specialist Clinic
ITB offers assessment and management of severe and widespread Spasticity for patients with various neurological disorders.
About our service
The Intrathecal Baclofen (ITB) Specialist Clinic offers assessment and management of severe and widespread Spasticity for patients with various neurological disorders.
The symptoms of Spasticity are treated in different ways depending on the severity and extent of muscle involvement. The aims are to reduce muscular spasms, discomfort, and pain and joint complications helping to improve posture and in some patients to aid functional recovery.
Who is the service for?
This service is aimed at candidates for Intrathecal Baclofen, who are patients with spasticity*, with intractable spasticity uncontrolled by drug therapy, or who experience intolerable side effects from oral medication.
*spacticity related to multiple sclerosis, cerebral palsy, spinal cord injury, brain injury and stroke
Advantages of Intrathecal Baclofen (ITB) therapy are:
1. Direct drug administration to the cerebrospinal Fluid (CSF):
- Intrathecal administration can use concentrations of baclofen of less than one hundredth of those orally.
- The central side effects of oral baclofen such as drowsiness or confusion appear to be minimized with intrathecal administration (due to the lower dosage used compared to oral baclofen).
- The intrathecal delivery of baclofen concentrates the drug in the CSF at higher levels than those attainable via the oral route.
2. Adjustable/ programmable continuous infusion makes it possible to finely titrate patient’s doses and to vary the doses over the hours of the day depending on the symptoms.
3. The treatment is reversible (in contrast to surgery) although this is rare for patients once they have commenced therapy.
Potential Side effects/Complications:
Adverse events reported are low in number and often temporary.
The majority of complications usually occur within the first few months following implantation, with further arising from inappropriate dose or programming errors.
Common pharmacological side effects can be drowsiness, somnolence, nausea and vomiting. Abrupt withdrawal of the Intrathecal Baclofen must be avoided as it can be lead to withdrawal side effects and fatality. Common system complications are related to catheters (tubes), that is, catheter dislocation, migration, or fracture and the procedure of implantation and refilling is infection.
Weight gain following implantation can occur but this may be desired in some patients. The incidences of this in our practice are very low (less than 1 per cent).
Referral process
You can be referred by a Health Care Professional who looks after you and is aware of your neurological condition and required goals (ProcessMap).
What will happen in the clinic?
- An assessment of patients needs and identification of goals.
- Arrange test for suitability of Intrathecal Baclofen therapy and referral for implementation of pumps
- Regular reviews, refills and dosage adjustment
- Patient and carer education
- Referral to other services e.g. Posture and Mobility, Orthotics
What we do at an assessment?
Following the initial assessment in clinic and agreeing the goals of treatment a test procedure is arranged. This is performed as a day case procedure at the Queen Elizabeth Hospital.
This procedure involves a bolus injection of baclofen directly into the intrathecal space, (CSF) fluid surrounding the spinal cord, using a lumber puncture. This is performed using local anaesthesia, in order to screen for patients response to treatment. Patients considered as candidates for pump implantation are those that have had a positive result from this test where the result is in keeping with patient’s goals.
What happens after the assessment?
Following a test procedure you will be meeting the team again to discuss the results and agree on the next course of action. If this treatment is appropriate for you, with your agreement, you will be referred to the surgeon for implantation of a pump.
The intrathecal pump delivers baclofen directly into CSF. The system consists of a catheter (tube) and a pump. The pump is surgically placed under the skin of the abdomen near the waistline, under general anaesthesia. The pump stores and releases prescribed amounts of medication through the catheter (tube). The pump reservoir is refilled approximately every 6 months by percutaneous injection (an injection through the skin into the pump reservoir). The pump is taken out and replaced at the end of the battery’s life span (approximately 5-7 years), this involves further surgery.
Relevant web pages and information
Please click on the links below for additional information:
www.medtronic.com
www.baclofen.info
Frequently asked questions
Will Intrathecal Baclofen (ITB) cure my spasticity?
No. Intrathecal baclofen manages the symptoms of severe spasticity only but cannot remove or cure the cause or underlying condition.
What happens in an emergency?
Once you are discharged home after implantation you will be given emergency contact and procedure information. It is important your carers or family are familiar with this as well. There is 24 hour cover in an emergency, please see the emergency contact information you receive for further details.
Will the pump be noticeable?
Dependent on the size of the patient, the pump may or may not be noticeable as a small bulge in the lower abdomen. Previous patients do report that after some time they get used to it.
Will the pump move inside me?
The surgical technique used does allow some movement of the pump in the abdomen but this has not been a major concern to our implanted patients.
Will I be able to fly in an aeroplane?
Yes. You will however need to take information for airport security checking from us and we need to ensure you will have enough medication in the pump to last the trip. Also take your emergency contact/ procedure file with you in case you have any problems.
What will happen to my other medication?
Some of the oral medications that you may have been taking for management of spasticity will be reduced or stopped after implantation. The reduction regime will be advice at that time.
What happens if the pump runs out of baclofen?
It is unlikely that a pump reservoir will completely empty provided you attend your arranged appointments. The pump has an alarm that will activate at a low reservoir level.