Treating Spastic Cerebral Palsy with a Baclofen Pump
Baclofen pumps can help minimize spasticity caused by cerebral palsy. Baclofen pumps are implants that continuously inject very low doses of spasticity control medication directly into the spinal fluid.
Spasticity and Muscle Tension in Cerebral Palsy
Individuals with spastic cerebral palsy have spasticity, a condition which makes physical movement look jerky due to muscle stiffness. This muscular stiffness is due to hypertonia (increased muscle tone). Relaxing muscular stiffness through treatment and therapy techniques can help to reduce some of the stiffness and, in turn, some of the jerky movements that accompany spastic cerebral palsy. The process of treatment requires a thorough evaluation of a child’s physical abilities and the benefits and risks of available drug regimens.
Before spasticity medications are prescribed, doctors evaluate a child’s motor function. They can use a scale like the Gross Motor Function Classification System (GMFCS), which measures motor function in day-to-day settings, or the Manual Ability Classification System (MACS). Other diagnostic tests and evaluations are also used to provide a comprehensive understanding of the degree of the child’s spasticity.
What is a Baclofen Pump for Cerebral Palsy?
Intrathecal Pain Pumps
An intrathecal pain pump is a pump that feeds medication directly into the spine for the relief of pain and/or spasticity. The pump is implanted into the abdomen and feeds medication into the spinal fluid via a small catheter. The pumps can be used for chronic and severe pain or for spasticity disorders resulting from conditions like cerebral palsy, multiple sclerosis, or spinal cord injury.
Baclofen (Lioresal) is a muscle relaxant medication used to help people with cerebral palsy and other motor disorders treat spasticity. This drug suppresses the release of the neurotransmitters that cause spasticity by decreasing the neuron’s excitability (how much the neuron responds to a particular signal). This, in turn, prevents the chain reaction that signals motor neurons to fire.
Baclofen can be administered orally (in a tablet form), transdermally (with a topical cream), or directly into the spinal fluid (intrathecal baclofen).
What is a Baclofen Pump?
Intrathecal baclofen (ITB) is baclofen that is administered via an intrathecal pump. This method of administration allows for lower doses than oral baclofen tablets. ITB is typically the preferred route of administration for spastic diplegia because very little oral baclofen actually reaches spinal fluid.
When an individual with cerebral palsy chooses to use a Baclofen pump to help treat his or her spastic cerebral palsy, medical professionals place the device in the patient’s abdomen. The pump is about the size of a hockey puck and continuously delivers the medicine into the fluid surrounding the patient’s spine.
What are the Advantages of Intrathecal Baclofen over Oral Baclofen?
There are several advantages to using intrathecal baclofen for treating severe spasticity:
- ITB is typically more effective in controlling spasticity because it is directly in contact with the spinal cord. With oral baclofen, the medication must first pass through other body systems such as the gastrointestinal system and the blood.
- Since the medicine goes directly into the nervous system with ITB, doses are lower than in oral tablets.
- Baclofen has a very short half-life (2-4 hours). Oral doses don’t allow for continuous delivery, while ITB does. This means that ITB allows for steadier spasticity relief.
- ITB has fewer side effects than oral baclofen, even at higher doses. Side effects include sleepiness, confusion, sedation, hypotonia, ataxia and nausea.
- Unlike oral baclofen, you can program different doses throughout the day. This precision timing allows for greater flexibility in treating spasticity.
- ITB therapy is reversible. If a child needs therapy to be halted, the pump can be stopped and removed.
Surgical Insertion of a Baclofen Pump
During surgery, the pump is placed under the skin of the patient’s abdomen. Once the pump is in place, the physician attaches a catheter to it. Then the physician threads the catheter under the skin at waist level to the patient’s spine. The catheter is inserted into the spinal canal.
Next, the physician fills the pump with baclofen and sets it to deliver the exact amount of medicine the patient needs. The pump begins slowly releasing the medicine through the tube and into the spinal canal.
How Long Does a Baclofen Pump Last?
Baclofen pumps must be filled with medicine every one to six months, depending on the patient’s dose. The pump lasts about five years. Afterward, it must be removed and replaced during another surgery due to wear and tear on the device.
Baclofen and baclofen pumps are effective in treating spasticity in many cases, provided that proper maintenance procedures and administration instructions are followed. We are including some additional information regarding baclofen pumps below for further information.
- The University of Michigan provides a comprehensive guide to baclofen pumps, including details regarding health risks, long-term care, and detailed descriptions for care.
- The National Institute of Health provides a detailed analysis of the effectiveness of baclofen pumps for readers who want more detail.
- UptoDate provides a comprehensive overview of cerebral palsy treatments and prognoses.
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Treatments for cerebral palsy, including baclofen pumps, can be expensive. Reiter & Walsh, P.C. focus on helping children with birth injuries and cerebral palsy caused by medical negligence secure the compensation they deserve. We provide free case evaluations to prospective clients. To further demonstrate our dedication to helping those impacted by birth injury, we do not charge any fees until the case has been won. Please contact us by phone (1-888-419-2229), or via our online contact form.
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