By Trey Eskew, PA-C
Spasticity is a muscle control disorder commonly found in people with cerebral palsy, traumatic brain injury, stroke, multiple sclerosis, and spinal cord injury. People with spasticity experience tight or stiff muscles and the inability to control those muscles, including painful spasms and tightness around joints.
Spasticity (from Greek spasmos-, meaning “drawing, pulling”)
At Neurology Solutions, we understand not only the discomfort associated with spasticity but its hindrance on everyday life such as keeping up with basic hygiene and mobility. If you or a family member are experiencing spasticity you may be wondering what are the best ways to treat the disorder and reduce symptoms.
Baclofen is a medication used to treat spasticity that relaxes skeletal muscles. Patients can take up to 90 mg of oral Baclofen per day. Unfortunately, when taken orally the medication can lead to adverse effects such as excessive drowsiness, confusion, mood changes, dizziness, weakness, headaches, nausea and trouble sleeping. For patients who experience these side effects with oral Baclofen, we may recommend trying Medtronic Intrathecal Baclofen Therapy (ITB), another form of treatment used for severe spasticity.
With ITB Therapy, a pump that dispenses liquid Baclofen is surgically implanted into the spinal column to deliver Baclofen on a continuous basis or on a dosing schedule determined by your doctor. The medicine is administered directly into the intrathecal space–an area of the spine into which spinal injections and pain pumps are inserted–to provide the patient medication to relieve their symptoms where it is needed most, in the patient’s upper or lower extremities. ITB treatment delivers smaller amounts of Baclofen than when it is taken orally because the intrathecal administration allows access to a much wider area of the central nervous system through cerebrospinal fluid circulation pathways, which can often reduce side effects. When starting the treatment, your doctor will give you a small dose and then gradually increase it to reduce side effects such as drowsiness.
Who is a candidate for ITB Therapy?
- Patients diagnosed with chronic spasticity (spasticity present for over 6 months)
- Patients who have already tried oral Baclofen and other conservative treatment options and have not benefited from them
- Patients who cannot tolerate the Baclofen dose necessary for symptom control
Evaluation and trial to determine benefits of ITB Therapy
When a patient is introduced to ITB Therapy, he or she will undergo an intrathecal Baclofen pump trial, where a small dose of Baclofen is injected into the intrathecal space surrounding the lumbar spine. The patient will be evaluated pre-and post injection to determine if there is any significant improvement in spasticity and function and for any possible adverse effects. If there is significant response to the trial, with no obvious adverse effects, Neurology Solutions will refer the patient to a neurosurgeon for evaluation and consideration of surgical implantation of the intrathecal baclofen pump.
Follow up and management in ITB Pump Therapy
Following surgical implantation of the pump, the patient will continue to follow up in the Neurology Solutions office for management of their pump. This includes programming by the clinician to adjust the daily dose of medication as well as periodic refilling of the pump with Baclofen. ITB pump refills occur approximately every three months.
The life span of the Medtronic ITB pump ranges from 4 to 6 years, at which time it is surgically removed and replaced with a new pump via an outpatient surgical procedure performed by a neurosurgeon.
Please contact us if you think ITB Pump Therapy may be right for you or have further questions about treating spasticity in yourself or a loved one.
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Trey is a certified Physicians Assistant. He joined Neurology Solutions in 2010.