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Baclofen is a drug produced as a muscle relaxant. It can relieve the stiffness caused by spasticity (tight and stiff muscle tone).
You can take Baclofen by mouth in a low dose. However, some patients do not respond well to oral medication and develop unacceptable side-effects.
It is often preferable to implant a system that can accurately and safely deliver drugs directly into the nervous system. By delivering the medication directly into the spinal cord where it is needed, improved effects can be achieved on smaller doses than with oral medications and some of the potential side-effects can be minimised.
Baclofen is delivered directly into the spinal fluid, by a pump implanted under the skin of the abdomen and connected to a thin flexible catheter. The catheter is tunnelled beneath the skin into the intrathecal space in the spinal cord, where it delivers a precisely controlled dose of the medication.
The function of the pump can be altered to suit the individual so if you or your child need a higher dose of medication at different times of day, the pump will be programmed to this effect. The pump is about the size of an ice hockey puck, but can be easily housed in the abdominal cavity.
Children as young as 5 have received ITB, but it does depend on the size of the cavity in the abdomen in which the pump sits.
ITB can give more independence in feeding and dressing and can make sitting and transferring more comfortable. It also helps carers in their role, with approximately 94% of caregivers being satisfied with ITB.
With cerebral palsy some of the specific benefits are:
Side-effects of Baclofen can include hypotonia (loose muscle tone), sleepiness, upset stomach, vomiting, headaches and dizziness.
ITB is a surgical procedure and like all surgery will carry risks such as infection, bruising, bleeding, spinal fluid leakage, headache and discomfort. The medical team will discuss all of these with you beforehand.
Some potential risks include those associated with the pump. For example, the tube may move, kink or break, or part of the pump may fail to work.
However, ITB is becoming more available and your child will be under the care of an experienced team so side-effects and risks are minimised.
This treatment will not be suitable for everyone who has cerebral palsy or a neurological condition. For example, it does not help people with:
It is recommended for severe generalised spasticity.
There is a clear screening process that is applied to each individual child or adult. The final stage, before the pump is inserted, is to give potential patients a test dose of Baclofen direct into the spine via a lumbar puncture. This lasts four hours and is to ensure that this method of delivering the drug is suitable. This test dose procedure will provide the medical team with a very strong indication of whether you or your child will benefit.
The key to the success of ITB is active involvement and co-operation with the medical team. It is extremely important to attend all outpatient visits for refills and follow-up assessment. Follow-up visits vary from weeks to months depending upon the dose of medication.
It's important that this treatment is accompanied by therapy. This can involve intensive physio and occupational therapy in the first few weeks after the operation. Therapy may continue for several months.
The pump is made from titanium and the catheter from silicone. Both these materials are unlikely to cause an adverse or allergic reaction.
The battery within the pump can last several years. During visits to your medical team, they will monitor the battery life and can schedule a pump replacement before the existing battery expires. The pump also has an alarm which will prompt you to see the medical team before the battery runs out.
There have been several research papers published around ITB and the administration of Baclofen. For further information see the booklet ITB Therapy published by Medtronic.
Funding for ITB can be inconsistent. Almost all medical and surgical treatments are funded by the patient's Primary Care Trust (PCT). The funding decision is based upon a number of factors that include the clinical need, the published evidence of the therapy, PCT priorities and the availability of funds.
Once you or your child have been assessed as suitable for ITB Therapy, the medical team contacts the relevant PCT for an agreement to fund. This process may take months on a waiting list until agreement is made. Occasionally funding is refused. If so, there is the right to appeal.
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Hi all, I am a Masters student at Liverpool John Moores University, I am currently carrying out a study on the effects of Horse Riding Therapy on adults with cerebral palsy.
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