Baclofen pills are often used to treat spasticity. In this form, however, the amount required to decrease spasticity often causes sleepiness. An intrathecal baclofen pump delivers the baclofen directly into the fluid around the spinal cord. A battery-operated pump the size of a hockey puck is placed (implanted) under the skin on the person’s trunk. The pump is connected to a small tube that delivers baclofen to the area around the spinal cord. Both are implanted during surgery. Everything is under the skin; on some people the pump can be felt under the skin on the abdomen. The pump works by a small computer that is programmed by the doctor. This way of delivering the baclofen decreases spasticity without drowsiness. The pump needs to be refilled every two to six months, depending on dose.
Who may benefit
Intrathecal baclofen pumps work best for people with cerebral palsy over the age of four who have spasticity in many muscles. It is also helpful for some patients with dystonia. An intrathecal baclofen pump may be considered when other treatments have not helpful and the person, family and medical team agree that there are goals the person could achieve with the pump that would otherwise continue to be a struggle. Because the pump needs to be refilled often, both the person and the family or caretaker must be willing and able to come to regular clinic appointments.
How it is done
Once the goals for the pump are identified, the person participates in a trial to see if the baclofen decreases his or her spasticity or dystonia. This is done in the hospital. An injection of the drug is given into the spinal space. A doctor and therapist evaluate to see if the movement disorder changes. If it is a lot less after the injection, the person, family and medical team discuss implanting a pump. The person goes home and returns to the hospital at another time to have the surgery to put in the pump. He or she is in the hospital for four or five days. To get the dose of drug that helps the most, frequent clinic visits are typically needed during the first six months after a pump is implanted. After that, the person comes back to the clinic for a reassessment, modification of dose if necessary and pump refill. These appointments may occur every two to six months, depending upon the dose of baclofen.