Baclofen pump - Medical specialists

What is Baclofen?

Baclofen is a drug that doctors use to treat the symptoms of severe spasticity. Patients can take the medication orally, which works very well for most people.

However, some patients experience the following side effects:

• Dizziness
• nausea
• drowsiness or
• muscle weakness

A Baclofen pump is then often used.

What is spasticity?

Spasticity is muscle stiffness that is accompanied by pain, spasms, immobility, malpositioning or abnormal reflexes. It occurs in the area of the spinal cord or the brain and can considerably restrict the quality of life of those affected.

People with spasticity suffer from a pathological increase in muscle tension @ Marcos /AdobeStock

When is a Baclofen pump used?

If the patient takes baclofen orally, the majority of the drug remains in the bloodstream. Even at high doses, only a small amount reaches the cerebrospinal fluid, the target of the drug.

With the help of a baclofen pump, the drug reaches the fluid in the spinal cord directly. Neurologists administer it through an ITB system exactly where it is needed. As a result, the dose is lower, the effectiveness is improved and there are fewer side effects.

How does a baclofen pump work?

A baclofen pump delivers a specific dose of intrathecal baclofen into the cerebrospinal fluid space (intrathecal space). A surgeon implants the pump in the abdominal cavity under the skin. He then connects it to a catheter (thin and flexible tube).

The surgeon then routes this to the cerebrospinal fluid space, where the tube delivers the medication regularly and in precise doses.

Surgery is usually performed under general anesthesia, which takes the surgeon about an hour. Neurologists then program the system in terms of dosage so that no undesirable side effects occur.

Doctors then have to replace or renew the medication every six months or so. This is done by means of a painless injection into the abdominal skin, under which the pump is also located.

The pump can also emit various alarms.

These include

• Acute alarm: For faults that doctors need to rectify immediately
• Refill alarm: Indicates that doctors need to refill the Baclofen pump
• Pump replacement alarm
• Double beep alarm: Occurs before the pump is finally switched off

Possible risks and side effects

In some patients, the drug Baclofen can lead to the following side effects:

• Dizziness
• headaches
• vomiting
• Drowsiness or
• Flaccid muscles

However, the operation itself also has various risks such as

• Nerve injuries
• headaches
• hematomas or
• infections

However, these occur very rarely. There may also be system-related risks. For example, the Baclofen pump may come loose, the catheter may tear, leak or kink. This leads to impairment of the pump function.

This in turn leads to withdrawal of the medication and the symptoms of spasticity reappear. However, system-related risks are also extremely rare.

Which patients are suitable for treatment with the baclofen pump?

Not every patient is suitable for treatment with a baclofen pump. For example, this form of therapy is only effective for spasticity in the legs, but not in the arms.

If patients suffer from connective tissue muscle contractures, a Baclofen pump is not effective. If connective tissue contractures occur, the muscles are transformed into strands that are very hard. This makes the legs immobile and stiff. However, physiotherapy prevents this in most cases.

Before an operation, doctors simulate the pump in a test by injecting the drug into the cerebrospinal fluid. In this way, they can determine whether the patient responds well to the treatment.

The attending physician then examines and observes the patient. Only after a positive Baclofen test does he or she recommend the use of a pump. Patients can expect to spend a week in a clinic for this. Health insurance companies usually cover the therapy costs.

Physiotherapy keeps the affected muscles and joints mobile @ n. tati.m /AdobeStock

Aftercare following implantation

You can have the stitches removed approximately two weeks after the operation. The attending physician will also check the wound.

A post-operative check-up takes placeafter approximately six weeks. The doctor will carry out further checks as part of the regular pump fillings.

Conclusion

Intrathecal Baclofen therapy is useful if the patient does not respond to standard therapy (physiotherapy). Baclofen therapy has been approved for adults suffering from severe spasticity since 1985.

This form of therapy has been available for children from the age of six since 1995 . The baclofen pump can reduce adverse drug reactions as the dosage is lower.

In addition, the pump always delivers the drug in a constant amount. This largely eliminates fluctuations in effect.

The pump delivers the drug Baclofen directly into the cerebrospinal fluid. This helps those affected to be able to lie, sit, walk or stand better again.