Karen Stanek MD, PHD
Michael Keith ARNP

(509) 624 - 0908

Intrathecal Pumps

NWMR specializes in Intrathecal Baclofen Therapy (ITB) for the management of severe spasticity. Spasticity is characterized by an altered skeletal muscle performance in muscle tone involving hypertonia (an unusual tightness of the muscles).Spasticity typically results from stroke, multiple sclerosis, traumatic brain injury, spinal cord injury and trauma.

Intrathecal pumps consist of a “hockey puck” size titanium pump that is implanted under the skin, in the abdomen, with a catheter into the intrathecal space in the spinal column and works by delivering small doses of medication directly to the spinal fluid. An Intrathecal pump is only implanted after more conservative therapies have failed and surgery is ruled out. The programmable pump delivers medication according to the rate determined. By delivering the medications in this manner it minimizes the side effects often associated with the higher dosages commonly found in oral medications of the same type.

ITP Indications, Safety and Warnings

More Information

If you would like to learn more about Baclofen Pumps, please visit the following websites. Baclofen Pumps

Intrathecal Baclofen in Multiple Sclerosis: Too little, too late?
Published online January 31, 2011 by Multiple Sclerosis Journal, this article summarizes the findings and recommendations of an expert panel on the use of ITB Therapy in the MS population.

Intrathecal Baclofen Therapy: Determining Appropriate Utilization in Patients With Severe Spasticity Related to Multiple Sclerosis
Neurology Reviews has just published this supplement focused on severe spasticity in MS. In this publication, Mark Gudesblatt, MD, and Stephen Koelbel, MD, discuss ITB Therapy in MS.

Intrathecal Pumps - Case Study 1

One of the Intrathecal Pump patients is a young lady who had debilitating spasticity because of a spinal cord injury. The severe muscle spasms in her arms and legs prevented her from reaching her goals of independence in her wheelchair, driving, feeding herself, living independently and attending school.

She tried multiple oral muscle relaxants but her tone and spasms could not be effectively managed with oral medications due to adverse affects (such as excessive sleepiness.) She also tried Botox injections for focal tone and spasms with limited success.

She underwent a Baclofen trial, which considerably decreased the muscle spasms during the trial, and was deemed a positive trial. She opted for the implant of an Intrathecal Pump for management of her spasms and tone.

She is now able to independently drive a vehicle with adaptive equipment, able to independently propel her manual wheelchair and is living independently. She has completed her educational goals and graduated from college in her chosen field.

7 / 11/ 2011

Intrathecal Pumps - Case Study 2

A gentleman was on large doses of oral narcotics and still not receiving good coverage of his pain. In addition, it had changed his personality from the large doses of narcotics. He was weaned from the pain medications over several months.

His trial of pain medication in the spinal column was positive. He elected to have an intrathecal pump placed. Presently, he is not on any oral narcotics. He is using very small doses of narcotics or microdosing in his pain pump. He returns to the clinic about every 90 days for a medication refill in his pump.

He is able to resume community activities with family and friends and once again be in social situations.

ITP Safety Information

Important Safety Information for ITB Therapy: Intrathecal Baclofen Withdrawal: Abrupt discontinuation of intrathecal baclofen, regardless of the cause, has resulted in sequelae that include high fever, altered mental status, exaggerated rebound spasticity, and muscle rigidity, that in rare cases has advanced to rhabdomyolysis, multiple organ-system failure, and death.

Prevention of abrupt discontinuation of intrathecal baclofen requires careful attention to programming and monitoring of the infusion system, refill scheduling and procedures, and pump alarms. Patients and caregivers should be advised of the importance of keeping scheduled refill visits and should be educated on the early symptoms of baclofen withdrawal. Special attention should be given to patients at risk (e.g., spinal cord injuries at T-6 or above, communication difficulties, history of withdrawal symptoms from oral or intrathecal baclofen).

This therapy is contraindicated in patients who are hypersensitive to baclofen. Implantation of the infusion system is contraindicated if the patient is of insufficient body size, requires a pump implant deeper than 2.5 cm, or, in the presence of spinal anomalies or active infection.

The most frequent drug adverse events vary by indication but include: hypotonia (34.7%), somnolence (20.9%), headache (10.7%), convulsion (10.0%), dizziness (8.0%), urinary retention (8.0%), nausea (7.3%), and paresthesia (6.7%). Pump system component failures leading to pump stall, or dosing/programming errors may result in clinically significant overdose or under dose. Acute massive overdose may result in coma and may be life threatening.

For more Indications, Safety and Warnings, please visit the Medtronics website.