If you and the team decide that intrathecal baclofen may be beneficial to you, you will then begin the trial and planning phase. Baclofen is an antispasticity medication delivered intrathecally by an implanted programmable pump. Given the cost of the implanted infusion pump, the potential complications. The drug is released by the pump and delivered through a. It can be given by mouth or intrathecally which means delivered into the space around the spinal cord. Long term intrathecal baclofen therapy for severe spasticity of cerebral. Intrathecal baclofen therapy versus conventional medical management for severe poststroke spasticity. Does intrathecal baclofen therapy increase prevalence and. New study shows superiority of intrathecal baclofen therapy. Intrathecal baclofen therapy fact sheet childrens health. This allows effective drug concentrations to reach the cerebrospinal fluid csf. Intrathecal baclofen itb therapy is an option for those in whom predominantly lower extremity spasticity is severe, problematic, and intractable to oral doses of. New study shows superiority of intrathecal baclofen.
Intrathecal baclofen therapy versus conventional medical. Subsequent animal studies demonstrated that intrathecal opioids produce powerful and highly selective analgesia 2. For spasticity of spinal cord origin, itb therapy should be reserved for patients unresponsive to oral baclofen therapy, or those who experience intolerable cns side effects at effective doses. Penn first described the application of intrathecal baclofen itb for individuals with spinal spasticity. Intrathecal baclofen itb is a well established therapy for children with movement problems. Ivb may be beneficial therapeutic option for patients with multiple itb pump revisions and risk of spinal. Rehabilitation after intrathecal baclofen pump placement. Lioresal intrathecal 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.
Despite the nearly 2 decades of widespread clinical use, this intervention presents many challenges to even experienced clinicians. Tizanidine introduction acute baclofen withdrawal and toxicity, either oral or intrathecal, can present with a constellation of symptoms making differentiation between these two entities and other potential diagnoses challenging 14. Intrathecal baclofen itb therapy using a programmable batterybased pump is a wellrecognized option in the treatment of patients with refractory spasticity. Patients should first respond to a screening dose of lioresal intrathecal prior to consideration for long term infusion via an implantable pump. Lioresal intrathecal baclofen injection important safety information indications and usage. Intrathecal baclofen for spastic hypertonia from stroke stroke. Patients tend to have had a good response from preoperative trials of intrathecal delivery to the spinal fluid baclofen and this is the permanent implantation phase.
It is a gammaaminobutyric acid gaba derivative which binds to presynaptic gaba b receptors within the brainstem, dorsal horn of the spinal cord, and other cns sites. Long term intrathecal baclofen therapy in patients with. After this visit, here are the next steps at a glance. Effect of intrathecal baclofen on pain and quality of life. 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. You will need to practice sitting and transfers before you leave the hospital. Intrathecal opioid therapy for management of chronic pain.
Improved outcomes and reduced costs through identification of catheter malfunction. 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. Aug 02, 2016 intrathecal baclofen itb therapy using a programmable batterybased pump is a wellrecognized option in the treatment of patients with refractory spasticity. Intrathecal baclofen therapy and the role of the physical. Treatment with intrathecal baclofen therapy itb therapysm. Postimplantation gtitrate dose to ensure balance, stability, and postural control ginstruct patient and caregiver about refill schedule, management of complications, and potential adverse effects grefills, assessments, and possible dose adjustments are at itb therapy center at 4 to 12week intervals. Intrathecal baclofen therapy itb is a wellknown treatment for spasticity.
Oral baclofen is usually tried first but if it doesnt work well, intrathecal baclofen. 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. Background intrathecal baclofen itb is a treatment option for patients with severe poststroke spasticity pss who have not reached their therapy goal with other interventions. As with most medications, overdose drug dose is too high or underdose drug dose is too low can.
When receiving itb therapy sm with lioresal intrathecal baclofen injection, make sure you follow your clinicians instructions closely. Of the 59 ms patients receiving itb therapy at our institution, the mean, median, and mode daily doses for itb are 184, 115, and 159 mcgday, respectively. You are advised to consult the publishers version publishers pdf if you. Intrathecal baclofen therapy may improve range of motion, facilitate movement, reduce the patients expenditure of energy, facilitate nursing, reduce the risk of developing contractures, and, in. Thousands of baclofen pumps have been implanted in the. Despite this fact, several topics have to be still discussed. The university of michigan was one of the centers that participated in the research trial that led to fda approval. Itb therapy with lioresal intrathecal baclofen injection is indicated for use in the management of severe spasticity resulting from stroke, spinal cord injury, multiple sclerosis, cerebral palsy and brain injury. Intrathecal baclofen therapy itb is approved by the u. Moda health medical necessity criteria intrathecal opioid therapy for management of chronic pain page 45 c1772 infusion pump, programmable implantable e0785 implantable intraspinal epidural intrathecal catheter used with implantable infusion pump, replacement j0476 injection, baclofen, 50 mcg for intrathecal trial.
Itb therapy using an implantable, programmable pump has now been widely adopted in the treatment of children with spasticity due to cerebral palsy cp. Successful intrathecal baclofen therapy for seronegative. Pharmacokinetics and pharmacodynamics of intrathecal baclofen therapy. Intrathecal baclofen therapy patients must be clinically stable one year post injury, not in an exacerbation, etc. Intrathecal baclofen therapy cooper university hospital. Baclofen is a medicine that helps the muscles relax. Intrathecal baclofen therapy in patients with multiple sclerosis. Patients on itb have reported reduced pain associated with spasticity, improved positioning, speech, quality of sleep and quality of life. Aug 14, 2018 schiess mc, oh ij, stimming ef, lucke j, acosta f, fisher s, et al. Lioresal intrathecal baclofen injection is a muscle relaxant and antispastic that is indicated for use in the management of severe spasticity of cerebral or spinal origin lioresal intrathecal is intended for use by the intrathecal route in single bolus test doses via spinal catheter or. Advancements in healthcare technology for patients with spasticity are promising. A surgeon implants a programmable pump and catheter so you can receive the medication. Intrathecal baclofen therapy itb therapy is delivered by the medtronic synchromed ii drug infusion system, which consists of an implantable, programmable pump and an intrathecal catheter. Intrathecal baclofen therapy used in the management of spasticity.
Does intrathecal baclofen therapy increase prevalence andor. The use of intrathecal baclofen therapy for myoclonus in a patient with lance adams syndrome. We report here our experience with ib therapy in a canadian centre over a four year period. Efficacy of intrathecal baclofen therapy in children with. The high itb doses in these patients and poor spasticity control raised suspicion for pumpcatheter malfunction and prompted immediate troubleshooting. Intrathecal baclofen therapy with lioresal intrathecal baclofen injection healthcare professionals. Functional benefits and costbenefit analysis of continuous intrathecal baclofen infusion for the management of severe spasticity. In the last decade, there has been a lot of excitement in the field of stroke rehabilitation with the introduction of 3 new therapies for spastic hypertonia. Information guide to intrathecal baclofen pump program. The purpose of this article is to describe intrathecal baclofen itb therapy and the physical therapists role in identifying appropriate candidates and patient management. Methods spasticity in strokerandomised study sisters was a randomised, controlled, openlabel, multicentre phase iv study to evaluate the efficacy and safety of itb therapy versus conventional medical. Schiess mc, oh ij, stimming ef, lucke j, acosta f, fisher s, et al. Lioresal intrathecal baclofen injection is administered directly to the intrathecal space surrounding the spinal cord. Rehabilitation after intrathecal baclofen pump placement key points your body might feel weak after the pump placement surgery.
A clinical study of intrathecal baclofen using a programmable pump for intractable spasticity. Since then more than 60,000 medtronic baclofen pumps have been used worldwide to manage severe spasticity in children and adults. Baclofen is usually taken by mouth several times per day. Prospective 12month study of intrathecal baclofen therapy for poststroke spastic upper and lower extremity motor control and functional improvement.
The therapy involves the infusion of baclofen contained in a pump implanted in the abdominal wall. 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. Intrathecal baclofen itb has a much greater effect with significantly reduced doses as opposed to oral baclofen that crosses the blood brain barrier poorly. Improvements in clinical scale scores for muscle spasticity among this heterogeneous group of patients may not reflect the functional benefits of this therapeutic option. Albright expanded its use to children with spasticity of cerebral origin shortly thereafter. Intrathecal baclofen itb therapy is a good therapeutic, evidencebased option and effective treatment for spasticity in children with cerebral palsy. Intrathecal baclofen therapy itb consists of delivering a liquid form of baclofen into the spinal fluid, using a device called a baclofen pump.
A sudden stop in therapy can result in serious baclofen withdrawal symptoms, such as high fever, changed mental status, muscle stiffness, and in rare cases, may result in the loss of function of many vital organs and death. Compare a group of individuals with cerebral palsy cp who had intrathecal baclofen itb pumps to a group of individuals with cp who did not have itb pumps in order to determine if there was a difference in the prevalence of newonset neuromuscular scoliosis, an increased rate of progression of preexisting neuromuscular scoliosis, or an increased rate of posterior spine fusion. Food and drug administration and indicated for the management of severe spasticity of. Complications of intrathecal baclofen pump therapy in pediatric patients. Highlights of prescribing information dose titration. This report highlights the unique features related to the rapid with. Intrathecal baclofen therapy michael d partington md, faap, faans gillette childrens specialty healthcare st paul mn no disclosures. Jun 12, 2018 intrathecal baclofen itb therapy has become popular as a breakthrough treatment for severe spasticity. Jan 11, 2018 patients should first respond to a screening dose of lioresal intrathecal prior to consideration for long term infusion via an implantable pump. Watve sv, sivan m, raza wa 2012 mangement of acute overdose or withdrawal state in intrathecal baclofen therapy. Intrathecal baclofen ib is a powerful and promising therapy for spasticity,1 but its expensive and invasive nature are poten tial barriers to its use. Background a baclofen pump is a hockeypuck size pump that is surgically placed just under the skin of your abdomen.
Intrathecal baclofen itb therapy has become popular as a breakthrough treatment for severe spasticity. Information guide to intrathecal baclofen pump program introduction. An overview of intrathecal baclofen management and troubleshooting aacpdm 2014 instructional course 31 introduction5 minuteskrach o itbvery effective intervention for tone reduction but requires. Pdf complications of intrathecal baclofen pump therapy. Intrathecal baclofen therapy used in the management of spasticity of. The success rate of baclofen pump implantation for delivery of baclofen to the spinal fluid is generally favorable. Intrathecal baclofen pump for muscle spasticity treatment. Request pdf on jul 1, 2008, takaomi taira and others published intrathecal baclofen therapy find, read and cite all the research you need on researchgate.
Intrathecal baclofen therapy in adults and guideline for clinical. To test whether continuous infusion of intrathecal baclofen is effective in comparison with standard treatment only. It has also been used in children with dystonic cerebral palsy. Intrathecal baclofen for spastic hypertonia from stroke. View the article pdf and any associated supplements and figures for a period of 48 hours. Intrathecal baclofen therapy baclofen is a muscle relaxant medication used to modulate spasticity and dystonia of cerebral or spinal origin. Nov 20, 2019 intrathecal baclofen therapy baclofen is a muscle relaxant medication used to modulate spasticity and dystonia of cerebral or spinal origin. Oct 18, 2011 individuals who are treated with intrathecal baclofen itb pump delivery system for intractable spasticity can suffer from severe morbidity as a result of acute overdose or withdrawal of itb. Intrathecal baclofen itb therapy is a treatment option that delivers medication directly to the fluid surrounding the spinal cord. It is a gammaaminobutyric acid gaba derivative which binds to presynaptic gaba b receptors within the. The dosage and administration of longterm intrathecal. Patients should first respond to a screening dose of lioresal intrathecal prior to consideration for long term infusion via an.
Itb is approved by the fda for the treatment of severe spasticity. Pdf continuous intrathecal baclofen application itb through an intracorporeal pump system is widely used in adults and children with. For long term treatment, the drug is placed into a pump that is surgically placed under the skin of your abdomen. Management of acute overdose or withdrawal state in.
An overview of intrathecal baclofen management and. Aug 16, 2018 itb therapy with lioresal intrathecal baclofen injection is indicated for use in the management of severe spasticity resulting from stroke, spinal cord injury, multiple sclerosis, cerebral palsy and brain injury. Can intrathecal baclofen therapy unleash functional recovery after stroke. Patients who fail to respond to oral baclofen or who have significant side effects with it can benefit from intrathecal baclofen itb delivered by a. In japan, a specialized lecture on itb therapy is required and all cases are registered.
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