Intrathecal Baclofen (ITB Therapy)Description
Baclofen acts on the central nervous system to relieve spasms, cramping, and tightness of muscles caused by spasticity in multiple sclerosis. Intrathecal baclofen therapy (ITB) consists of long-term delivery of baclofen to the intrathecal space in the spinal column. It is used in MS for those individuals with severe spasticity whose symptoms are not sufficiently relieved with oral baclofen and other oral medications. Because ITB is administered directly in to the intrathecal space, it provides better spasticity reduction at lower doses than can be achieved with oral medications that, at higher doses, can produce sedation, sleepiness, and imbalance.
Intrathecal baclofen is available as Lioresal Intrathecal or as Gablofen (a branded generic form of the drug).
Individuals who are considered candidates for intrathecal baclofen are given a test dose via lumbar puncture. Those who respond positively to the test dose can be considered for ongoing ITB therapy.
The SynchroMed® Infusion System (Medtronic) consists of: a small titanium disk, about three inches in diameter and one inch thick, which contains a refillable reservoir for the liquid; a computer chip that regulates the battery-operated pump; and a flexible silicone catheter that serves as the pathway from the pump to the intrathecal space.
Implantation of the pump requires two incisions, one in the lower abdomen to create a pocket for the pump, and another one in the lower back for inserting the catheter that is looped around the torso, inside the body, connecting the pump to the intrathecal space.
The dose of medication delivered by the pump is programmed and subsequently adjusted if necessary by non-invasive radio-telemetry. The pump is refilled every 4 to 12 weeks by injection in a procedure lasting about 20 minutes.
To prevent the baclofen supply from running out, the pump contains a programmable alarm that sounds whenever the reservoir need to be refilled, the battery is low, or the pump is malfunctioning in some way. In the event that the alarm sounds, you should contact your physician immediately.
Click here to read the Lioresal Intrathecal Prescribing Information for healthcare professionals.