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Intrathecal Baclofen (ITB)

  • Spasticity occurs when there is an insult to the brain or spinal cord causing a signal mismatch between the muscles as well as the brain or spinal cord. This mismatch causes the muscles to tighten and spasm.

  • Conditions which can cause the spasticity include spinal cord injury, cerebral palsy, brain injury such as a stroke, and multiple sclerosis. There are also inherited conditions such as hereditary spastic paraparesis (HSP) which can also result in spasticity.

  • Initially patients will try oral medications such as oral baclofen, tizanidine, or diazepam which may or may not help. In addition, sometimes patients are unable to tolerate the side effects of oral medications.

  • Botulinum injections can be used to treat spasticity as well as intrathecal baclofen or ITB.

  • If the baclofen is delivered into the intrathecal space (where the spinal fluid lives that normally bathes the spinal cord, brain, and nerves), spasticity is usually lessened without the excessive side effects associated with oral medications.

  • The system includes a programmable drug pump which is typically located in the abdomen below the skin internally.

  • A catheter connects to the drug pump and is placed into the spinal column so that the medication is delivered directly into the spinal fluid.

  • The movement disorder specialist will program the pump via remote control in the office setting allowing personalized adjustments and specialized programming for the patient specific needs.

  • Prior to the placement of the pump, a screening test is performed which typically involves a spinal tap (lumbar puncture) and injecting a test dose of medication into the spinal fluid. During this time, the patient is monitored for improvement in spasticity and also assessed typically with a physical therapist before and after therapy. The test dose typically takes 30 to 60 minutes to start taking effect and peaks at four hours.

  • If the patient has improvement in spasticity, they are then deemed good candidate for the intrathecal baclofen pump.

  • ITB is a very effective therapy that is often underutilized and can make the world of difference to the patient and their family.

  • For more information, please contact our team at Texas Movement Disorder Specialists, PLLC.

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