Intrathecal Baclofen Therapy and Cerebral Palsy
The most common form of cerebral palsy is spastic cerebral palsy, where the muscles become tight, and movements are stiff, jerky and difficult to control. Intrathecal baclofen therapy is a treatment option with potential benefits for patients with cerebral palsy as well as those with other similar conditions. If you’re looking for a way to improve muscle stiffness and increase the effectiveness of other types of therapies, intrathecal baclofen may be a compelling option.
What Is Intrathecal Baclofen Therapy Used to Treat?
Intrathecal baclofen (ITB) therapy is used to relax muscles and relieve spasms, tightness, and cramps. It eases spasticity, which is a condition where the muscles tighten, and resist being stretched. Baclofen can also help treat dystonia, which is a movement disorder that causes muscle contractions. ITB therapy is most used for patients with:
- Cerebral palsy
- Multiple sclerosis
- Spinal injuries
ITB trials have also been used for patients with traumatic brain injury and hypoxic brain injury.
ITB therapy is not a cure for any of these conditions. Rather, it’s an effective treatment option for symptoms related to the muscles. Intrathecal baclofen therapy may help other treatments, such as physical therapy and speech therapy, to be more effective.
How Does Intrathecal Baclofen Therapy Work?
One function of the body’s nerve system is to send electrical signals to the muscles telling them when to tense and when to relax. When the nerves are damaged, these signals can be disrupted, which may result in spasticity. This disrupts proper movement, gait, and speech.
ITB therapy for spasticity restores the electrical signals to the muscles, allowing them to work properly. This medication can also relieve the pain associated with tight, stiff muscles.
Intrathecal baclofen is delivered via a battery-operated pump, surgically placed inside the body near the abdomen. The pump then delivers baclofen directly in the spinal fluid via a thin silicone tube known as a catheter. This delivery method allows for uninterrupted delivery of the medication, unlike a pill. The pump is controlled via a computer program that doctors can use to adjust the quantity and frequency of baclofen delivery.
The surgical placement of the pump typically takes between one and four hours, during which the patient is under anesthesia. Patients usually remain on bed rest for two or three days after the surgery and stay in the hospital for four to six days post-op.
A medical professional must refill the medication in the pump every one to six months. This is done using a needle that goes through the skin and directly into the pump. The baclofen pump itself must be replaced every five years, which requires another similar surgery.
With regular delivery of baclofen, children with cerebral palsy can enjoy:
- Better range of motion
- Improved gait
- Relief from tightened muscles
- Reduced pain related to spasticity
Potential Side Effects
Patients typically indicate that the baclofen pump is not restrictive or uncomfortable. It shouldn’t restrict the patient’s movements and is usually concealed easily under normal clothing. The most common side effects associated with ITB therapy for cerebral palsy are:
There are some potential risks associated with the surgery required to place a baclofen pump. These include:
- Trouble with bladder control
- Malfunction of the pump
It is not uncommon for patients to require intrathecal baclofen pump revision surgeries that are not related to the end of the pump’s life. One study conducted at the Oakwood Health System in Dearborn, Michigan, surveyed 44 patients with these pumps. Of these patients, eight required 14 revision surgeries. Of the 14 revision-only patients included in the survey, seven patients required 13 procedures. Some of the issues associated with the intrathecal baclofen pumps included:
- Pump-catheter connector defect
- Fractured catheter with intrathecal fragment
- Implant infection
- Occult CSF leakage
- Intrinsic pump failure
Such complications can be minimized with meticulous surgical technique, an appropriate workup, timely surgical management, and high clinical suspicion.
Patients may not get ITB therapy if they have any contraindications for the use of an intrathecal catheter. These include:
- Anticoagulant therapy
- Anatomical abnormality of the spine
- Local or systemic infection
- Body size insufficient to support the weight and bulk of the pump
- Use of other implanted programmable devices that may crosstalk between one another, compromising the accuracy and effectiveness of one or both
Prior to the surgical implantation of the device, the patient must be assessed for any contraindications for the surgery, which include:
- Upper respiratory tract infection
- Lower respiratory tract infection
Patients must also respond positively to the medication baclofen for cerebral therapy in order to use ITB therapy. Anyone with an allergy or hypersensitivity to baclofen may not use this therapy.
Baclofen is available in an oral form as well as the liquid that’s delivered through ITB therapy. If you’re interested in this potential treatment for cerebral palsy, you should speak with your healthcare provider about the best approach.
If you’re concerned that your child’s cerebral palsy resulted from medical negligence, contact the Cerebral Palsy Family Lawyers at Janet, Janet & Suggs to talk through your potential case. You may be eligible for compensation that could help with the costs of some treatment options.
Claire Surles, RN
Claire comes to JJS after a 10-year career as a labor and delivery nurse. She dedicated her hospital efforts to advocating for families, providing the safest birthing environment possible as Newborn Admission Nurse at UMMC St. Joseph Medical Center in Towson, Maryland. Her passion for helping those who experienced losses at any stage of gestation led to her appointment as Coordinator of the hospital’s ROOTS perinatal loss program. READ FULL BIO