Mar 24, 2012 intrathecal baclofen pumps, although very gratifying, have a high, techniquerelated complication incidence during implant life. Prior to pump implantation and initiation of chronic infusion of lioresal intrathecal baclofen injection, patients must demonstrate a positive clinical response to a lioresal intrathecal bolus dose administered intrathecally in a screening trial. Itb pumps are widely used in the treatment of intractable spasticity for many clinical. Review article imaging evaluation of intrathecal baclofen pump catheter systems a. Itb therapy is intrathecal baclofen therapy, a treatment option that delivers an injectable form of baclofen, lioresal intrathecal baclofen injection, directly to the fluid surrounding the spinal cord. Long term intrathecal baclofen therapy is administered via a surgically implanted programmable pump that continuously infuses baclofen into the intrathecal space. The intrathecal baclofen pump is a surgically implanted device which allows delivery of a small amount of antispasticity medicine lioresal or baclofen to be delivered around the spinal cord. Baclofen can also be delivered through an intrathecal pump. Possible complications for certain patients with spasticity, an intrathecal baclofen itb pump offers many benefits. Answer the system, made of a catheter and a pump, delivers baclofen into the spinal fluid. Pdf increasingly, spasticity is managed with surgically implanted intrathecal baclofen pumps. It can be given by mouth or intrathecally which means delivered into the space around the spinal cord. Pdf imaging evaluation of intrathecal baclofen pump.
Thousands of baclofen pumps have been implanted in the. Baclofen is a medicine that helps the muscles relax. Clinical policy implantable intrathecal pain pump page 2 of 9 ii. Patients should first respond to a screening dose of intrathecal baclofen prior to consideration for long term infusion via an implantable pump. Intrathecal baclofen therapy in patients with multiple. An overview of intrathecal baclofen management and. Lioresal intrathecal is for use in single bolus intrathecal injections via a catheter placed in the lumbar intrathecal space or injection by lumbar puncture and in implantable pumps approved by the fda specifically for the intrathecal administration of baclofen.
Intrathecal baclofen pump revision surgery unrelated to. Intrathecal baclofen pump for sever spasticity uw health. Meticulous technique, high clinical suspicion, appropriate workup, and timely surgical management can reduce surgical complications of intrathecal baclofen pump implantation. Page 2 intrathecal catheter, for use with prometra programmable infusion systems indications the intrathecal catheter is indicated for use in patients receiving a flowonix programmable pump. The medicine delivered by the pump helps lessen the amount of spasticity in your muscles, making it easier for you to function and for someone to help care for you. Lioresal intrathecal baclofen injection is indicated for use in the management of severe spasticity. Intrathecal baclofen therapy itb consists of delivering a liquid form of baclofen into the spinal fluid, using a device called a baclofen pump. Intrathecal baclofen therapy itb therapy sm is delivered by the medtronic synchromed drug infusion system, which consists of an implantable, programmable pump and an intrathecal catheter. Codman medstream was fdaapproved for intrathecal baclofen and morphine infusion but has been taken off the market owing to fda recall. Lioresal intrathecal fda prescribing information, side. Pdf continuous intrathecal baclofen application itb through an intracorporeal pump system is widely used in adults and children with. Intrathecal baclofen pump baclofen is a muscle relaxant medicine commonly used to decrease spasticity related to multiple sclerosis, spinal cord injuries, or other neurological diseases. An intrathecal pump is a medical device used to deliver via an intrathecal catheter medications directly into the space between the spinal cord and the protective sheath surrounding the spinal cord. Intrathecal baclofen therapy, given via an implanted pump in the abdominal wall either as a continuous infusion or bolus dosing, has.
Intrathecal baclofen therapy used in the management of spasticity of. The screening trial employs lioresal intrathecal at a concentration of 50 mcgml. The university of michigan was one of the centers that participated in the research trial that led to fda approval. Postop discharge instructions intrathecal baclofen pump before leaving vancouver hospital, know your next appointment with intrathecal baclofen clinic or telephone asap to make arrangements to be seen within 5 7days after hospital discharge. Since then more than 60,000 medtronic baclofen pumps have been used worldwide to manage severe spasticity in children and adults. Intrathecal therapy tallahassee memorial healthcare. Commonly billed codes for intrathecal baclofen therapy. Its made of a catheter a small, flexible tube and a pump. One patients catheter was found to be disconnected from the pump and the others catheter tip was outside the intrathecal space. Intrathecal baclofen pump for muscle spasticity treatment. For spasticity of spinal cord origin, chronic infusion of. Lioresal intrathecal baclofen injection is administered directly to the intrathecal space surrounding the spinal cord. Medications such as baclofen, bupivacaine, clonidine, morphine, or ziconotide may be delivered in this manner to minimize the side effects often. Intrathecal baclofen therapy used in the management of spasticity.
Intrathecal baclofen pump an overview sciencedirect topics. Results from 295 patients, 27 had ct contrast study. Introduction and purpose the technique of intrathecal drug delivery itdd is based on the principle that effective analgesia can be achieved by the action of some drugs at the dorsal horn where adequate concentrations cannot be achieved. For long term treatment, the drug is placed into a pump that is surgically placed under the skin of your abdomen. You are advised to consult the publishers version publishers pdf if you. Baclofen pump therapy for the treatment of spasticity.
Oral baclofen is usually tried first but if it doesnt work well, intrathecal baclofen. Rehabilitation after intrathecal baclofen pump placement key points your body might feel weak after the pump placement surgery. This type of treatment, called intrathecal baclofen itb, can help people who have a hard time with side effects of the pill form. Baclofen pump refills will occur every 16 months depending on the dose your child needs. Because of the possibility of potentially lifethreatening cns depression. Rehabilitation after intrathecal baclofen pump placement. In both cases, the patients were not receiving the therapy. Information guide to intrathecal baclofen pump program introduction. Prevention of abrupt discontinuation of intrathecal baclofen requires careful attention to programming and monitoring of the infusion system, refill scheduling and procedures, and pump alarms. Lioresal intrathecal baclofen injection is intended for use by the intrathecal route in single bolus test doses via spinal catheter or lumbar puncture and, for chronic use, only in implantable pumps approved by the fda specifically for the administration of lioresal intrathecal into the intrathecal space. Intrathecal baclofen therapy and the role of the physical th. The medication is delivered using a programmable pump that is surgically placed and connected to a catheter in the body.
Doctors use a pump system to deliver baclofen directly into the spinal fluid. Evidence of the effects of intrathecal baclofen for spastic. Baclofen is usually taken by mouth several times per day. Intrathecal baclofen itb therapy is an option for those in whom predominantly lower extremity spasticity is severe, problematic, and intractable to oral doses of. Intrathecal baclofen itb is a well established therapy for children with movement problems. Intrathecal baclofen therapy itb is a treatment using lioresal intrathecal baclofen that is delivered into the fluid around your spinal cord intrathecal to help manage severe spasticity. The total pooled sample size of all included studies was 162 subjects.
Objective intrathecal baclofen pump is an effective treatment for spasticity. Baclofen is delivered directly into the intrathecal space via a surgically implanted infusion system. An overview of intrathecal baclofen management and troubleshooting aacpdm 2014 instructional course 31 introduction5 minuteskrach o itbvery effective intervention for tone reduction but requires. An intrathecal baclofen pump is indicated for patients with severe spasticity who do not respond to oral baclofen. It delivers the drug right to the spinal cord, so it doesnt. Treating spastic cerebral palsy with a baclofen pump. It is the policy of health plans affiliated with centene corporation that implantation of a permanent epidural or intrathecal pain pump to administer an opioid drug, singly or in. An intrathecal delivery system, which provides the baclofen right to the target site in the spinal cord, is an effective way to deliver the medicine. Evaluation of intrathecal baclofen delivery system. A surgeon puts the device a metal disc, about 1 inch. After pump catheter replacement, both patients received excellent clinical benefits from itb at significantly lower daily doses. Baclofen candidate determination patient arrives early, has physical therapy assessment using ashworth score 50 mcg intrathecal baclofen injection via spinal tap pt assessment 2 and 4 hours after baclofen discharged home at 8 hours after baclofen if no benefit may repeat at 75 mcg test dose and 100 mcg test dose.
Patients and caregivers should be advised of the importance of keeping. Examining the effectiveness of intrathecal baclofen on. Baclofen is an antispasticity medication delivered intrathecally by an implanted programmable pump. Background a baclofen pump is a hockeypuck size pump that is surgically placed just under the skin of your abdomen. Intrathecal baclofen itb has a much greater effect with significantly reduced doses as opposed to oral baclofen that crosses the blood brain barrier poorly. You will need to practice sitting and transfers before you leave the hospital. Itb is approved by the fda for the treatment of severe spasticity. Pharmacokinetics and pharmacodynamics of intrathecal baclofen therapy. Intrathecal baclofen pumps fact sheet womens and childrens. Baclofen lioresal is a muscle relaxant commonly used as an oral medication for the treatment of spasticity in children and adults with cerebral palsy. Only patients with ct evaluation who had revision pump catheter surgery were included. Information guide to intrathecal baclofen pump program. The first refill may not be for several months after the operation but. The intrathecal catheter is intended to be attached to the programmable pump to provide access to the intrathecal space.
805 170 344 1043 856 830 550 1592 592 196 797 1155 1027 1397 1582 519 1179 637 1297 427 984 662 546 1519 439 842 174 1341 1063 831 723 911 1358 1493 1325 64 890 685 1164 470 182 1267 937 550 1211 823 306 1161 1036