Intrathecal Baclofen (ITB) Therapy

Intrathecal baclofen (ITB) therapy uses a surgically implanted pump to deliver muscle-relaxing medication directly to the fluid surrounding the spinal cord to reduce spasticity. When taken by mouth, only a small amount reaches the spinal cord. The pump bypasses that problem by delivering the medication exactly where it's needed, at a much lower dose.

How it works

The ITB system has two components:

• Pump: A small, programmable pump (about the size of a hockey puck) is surgically implanted under the skin of the abdomen. 
• Catheter: A thin tube connects the pump to the spinal canal, where it continuously delivers a controlled amount of baclofen into the spinal fluid throughout the day. 

Trial before implantation

Before a permanent pump is implanted, your child will undergo a baclofen trial to determine whether ITB therapy is likely to be effective.

During the trial:

• A single dose of baclofen is injected into the spinal fluid through a lumbar puncture (spinal tap). 
• The care team monitors your child over several hours to assess changes in muscle tone and function. 
• If the trial demonstrates a meaningful reduction in spasticity, your child may be a candidate for permanent pump implantation.

Who is a candidate

ITB is used for children with spasticity that affects large areas of the body, particularly both legs or both legs and arms. It is commonly considered for children whose spasticity causes pain, difficulty with positioning, impairments in daily activities, or problems with care. It can also help children who are walking but limited by tone. 

Unlike rhizotomy, which is permanent and irreversible, the ITB dose can be increased, decreased, or turned off entirely.

What to expect after surgery

The pump implantation takes about 1 to 2 hours. Most children stay in the hospital for 2 to 3 days. Over the following weeks, your child's doctor adjusts the dose during clinic visits to find the right balance between reducing tone and maintaining function.

The pump reservoir holds a limited supply of medication and needs to be refilled every 2 to 6 months, depending on the dose. Refills are done in clinic with a needle through the skin; no surgery is required. The pump battery lasts about 5 to 7 years, after which the pump is replaced in a short outpatient procedure.