Interthecal Baclofen Pump by 6B0Jc44E

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									      Christina A. Hughes, MD
Director, MS Regional Program
          VA Puget Sound HCS
 Tightnessor stiffness in the muscles that
 impairs normal smooth motion.
  • May be beneficial:
     Improved “strength” for transfers/mobility
     Improved blood flow
     Decreased swelling
 TreatSpasticity when it begins to
 interfere with function, care-giving or
 causes discomfort
 Stretchingand other modalities
 Oral medications
  •   Baclofen
  •   Tizanidine
  •   Clonazepam
  •   Dantrolene
  •   Valium
  •   Gabapentin
 Injections
   • Botulinum toxin
   • Phenol
 Intrathecal Baclofen
 Reduce    spasticity that interferes with
  activity, care and comfort
 Facilitate rehabilitation therapies
 Improve function
 Improve ADLs
 Prevent spasticity related complications
  • Pressure ulcers, contractures, pain
 Reduce   caregiver burden
  • Improve hygiene, transfers, catheterization
 Small Titanium    Disk (3cm diameter x 1cm
 thick)
  • Refillable Reservoir for liquid Medication
  • Computer chip regulates battery-operated
   pump
 Flexiblesilicone catheter directs
  medication to intrathecal space.
 Pump refilled every 1-3 months
 Pump replaced every 5-7 years
   Person with MS who has significant spasticity that
        interferes with function, care-taking or causes
        discomfort.
   Other therapy options are ineffective
   Other therapy options have too many side-effects
   Person is able to comply with refill and maintenance
    schedules
   Person lives in an area that has quick access to care in
    case of pump system difficulties.
   Person has sufficient body size to implant pump system
   Person does NOT have an active infection
   Person does NOT have hypersensitivity to baclofen
   Person has trialed test dose and had effective response
 Try before you buy theory
 Given test dose of intrathecal baclofen inserted
  through a needle.
 Works in 1-2 hrs
  • Look for improved ROM
  • Look for reduction in spasticity
 Wears off in 4-8 hrs
 May not be perfect dose
  • OK because pump is fully titratible and
    programmable
 May   repeat test trial at different dose
 Requires General Anesthesia
 1st incision – Lower Abdomen
  • Create a pocket for pump beneath skin (above
   muscle layer)
 2nd   incision – Lower Back
  • Insertion site for catheter to enter Intrathecal
   Space
 Catheter  is tunneled from back to lower
  abdomen to connect to pump.
 Incisions heal in about 2 weeks
 Anesthesia   risks
 Bleeding
 Infection
 Spinal  Fluid leak
 Initial alteration in bladder control
 Initial alteration in spasticity control
  requiring titration of intrathecal
  medication
 Pump   Malfunction
  • Delivery of too much medication
     Baclofen Overdose
  • Delivery of too little medication
     Baclofen Withdrawal
 Catheter   Malfunction
  • Kinked catheter
 Symptoms
   • Drowsiness, lightheadedness, dizziness, somnolence,
    respiratory depression, seizures, loss of
    consciousness or comma.
 Treatment
   • Be evaluated by a physician immediately
   • Maintain proper airway and breathing precautions
   • Empty pump reservoir
   • May be given physostigmine
   • May have Lumbar puncture to reduce baclofen in
    CSF
 Symptoms    of Underdose
 • Itching, low blood pressure, new sensory
  symptoms, fever, change in mental status
 Symptoms    of Withdrawal
 • High fever, change in mental status, severe
   increase in spasticity or muscle stiffness.
 • In severe cases can lead to muscle breakdown,
   multiple organ failure or death.
 Immediately   contact a physician (or ER)
  that is experienced with ITB therapy.
   • Even if symptoms seem mild
   • Have person and pump evaluated
   • Restore intrathecal baclofen infusion


 If   ITB therapy is unavailable
   • Start high-dose oral baclofen
   • Use IV benzodiazepines as needed
 Your   physician will
  • Interrogate the pump status
  • Check x-rays of the pump and catheter system
  • Perform a pump refill procedure
  • System troubleshooting procedures
  • If needed, surgical repair, revision or
   replacement of system components.
 Clinic Procedure taking about 20 minutes
 Uses a handheld device placed on skin to
  program the pump
 Sterile technique to access port
  • Needle inserted through skin to access port
    reservoir
  • Remove any Medication left
  • Refill reservoir fully with liquid Baclofen.
  • Reprogram pump to desired dosing schedule
 OK   to go through metal detectors
  • May set off alarm – have ID card with you
 OT  to have CT scan
 OK to have MRI (must interrogate pump
  afterwards)
 OK to continue stretching and activities
 OK to be near household appliances
 OK to scuba-dive (up to 10 meters)
 www. Va.gov/MS
 www.nationalmssociety.org
 www.msworld.org
 http://professional.medtronic.com/thera
  pies/intrathecal-baclofen-therapy-for-
  severe-spasticity/
 www.webmd.com
 www.medicinenet.com

								
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