Intrathecal Baclofen (ITB) therapy is an FDA-approved treatment option for severe spasticity wherein Baclofen (a medication used to treat spasticity) is delivered directly to the fluid around the spinal cord through a surgically placed programmable pump and catheter. Once this form of treatment is considered appropriate for your child, thorough discussions will be had regarding the benefits and possible complications associated with this type of intervention. Having an ITB pump requires the patient and family to consistently attend their scheduled appointments for required pump programming maintenance and pump refills. The frequency of the ITB pump refills depends on the therapeutic dose for the individual. The pump has a battery life of approximately 4-7 years, so prior to the battery needing replaced, a surgery to remove the old ITB pump and place a new ITB pump will be scheduled.
Steps involved in consideration for an ITB pump:
1. Clinical evaluations by:
a. Physical Medicine and Rehabilitation (PM&R) Physician
c. Physical Therapist
d. Designated ITB Nurse/Provider:
i. Completion of Quality of Life Survey/questionnaire
ii. Determination of goals of ITB treatment
iii. ITB education
2. Screening Trial: A test dose of baclofen is given via lumbar puncture or via a catheter into the spinal canal for observation and evaluation of the effect of intrathecal baclofen on the individual. The trial is usually done as a day surgery procedure. If a continuous catheter trial is needed, your child will be admitted in the hospital for about 3-5 days.
3. Clinic visit with your PM&R doctor and Neurosurgeon to discuss decisions regarding baclofen pump system implantation and surgery date if all are in agreement to go forward with ITB pump placement.
4. ITB pump implantation: Your child will be admitted for 3-5 days for ITB pump placement and initial pump dose adjustments prior to going home. Wheelchair adjustments, physical therapy, and ITB education will be done during this hospitalization.
5. Subsequent follow-up in clinic will be schedule with Neurosurgery immediately after surgery and with the PM&R service for ongoing ITB pump adjustments and refills.