Baclofen Pump Trial
What is spasticity?
Spasticity (spaz-tiss-ih-tee) is a tightness or stiffness that makes it difficult to move your arms and legs the way you want them to move. These abnormal muscle contractions happen when nerve signals do not travel properly from the brain or spinal cord to the muscles. Spinal cord injury, multiple sclerosis, cerebral palsy and some hereditary conditions may cause spasticity.
What is intrathecal baclofen?
Medications taken by mouth are the first line of treatment for spasticity. To decrease spasticity, your doctor may have prescribed baclofen, Dantrium, Valium, Zanaflex or other oral medications. These medications are not always effective. It is possible they may produce side effects such as weakness, drowsiness or nausea. In the past, if medications taken by mouth were not tolerated because of side effects or were not effective, the only remaining option was irreversible surgery to destroy nerve connections. Baclofen can now be given directly into the spinal fluid. This method of medication delivery is called intrathecal (IN-tra-THEE-cul) therapy. The drug is delivered by a pump that is implanted under the skin. Baclofen has been approved by the Food and Drug Administration (FDA) for this purpose. When baclofen is put into the spinal fluid, the effectiveness of the drug is improved and the side effects are reduced. If you would like to be considered for this surgery, you must first undergo a trial dose of baclofen to make sure that it will work. The trial involves a lumbar puncture (spinal tap) and an injection of a small dose of baclofen into the spinal fluid. You are then observed for several hours. During this time of observation, medical staff will keep track of the amout of oxygen in your blood, your blood pressure and changes in spasticity. If significant improvement occurs, surgery to implant the infusion pump may be considered.
How can this system help me?
Intrathecal baclofen is not a cure for what is causing your spasticity. It can, however, decrease your spasticity so that your daily activities may improve. You may experience much less muscle stiffness, which will make it easier for you to move or to be positioned by your family or caregiver. You may also find less resistance to moving your legs for dressing or using the toilet. Less joint tightness will also help with the use of braces and splints. If spasticity has caused you to have disturbed sleep or pain, these symptoms may also improve. Side effects associated with medications taken by mouth will improve as these medications are slowly tapered and eventually stopped.
What should I expect during my appointment?
You will have an initial meeting with a nurse. Following this meeting, an IV will be started. This will allow intravenous medication to be given to help deal with any side effects you may experience. The physician will then administer a dose of baclofen directly into the spinal fluid. Following the procedure you will be transferred to the recovery area for ongoing monitoring. An evaluation by a physical therapist will be performed. If you are doing well and experience no complications, you will be discharged after a few hours.
On the day of your appointment:
- Notify us immediately if you are on Coumadin or Plavix
- Take your regular medications as scheduled
- Do not take your morning dose of baclofen unless told otherwise
- Most of these appointments are set for early in the morning, around 7:30am
- Bring a lunch with you as you might be finishing around this time
- Do not eat solid food for six hours prior to your appointment
- Bring a detailed list of all medications that you take including the dose and scheduled times
- Bring all medications you are scheduled to take during your clinic stay