Baclofen Injection

• Baclofen injection is delivered to the CSF and thought to act at GABAb receptor sites at the spinal cord
• Lower doses than those required orally
• Potential for fewer systemic side effects
• Pharmacokinetics
• 600 mcg/day dose: 1.24 mcg/mL IT lumbar concentration
• Lumbar to cervical concentration is 4:1
• Half-life 4-5 hours

Oral Baclofen

• Low blood/brain barrier penetration, with high systemic absorption and low CNS absorption
• Lack of preferential spinal cord distribution
• Some patients experience unacceptable side effects at effective doses
• Pharmacokinetics : 60 mg dose: 0.024 mcg/mL IT lumbar concentrationHalf-life 3-4 hours

Advantages of ITB^TM Therapy

• Reversible
• Potentially fewer systemic side effects
• Programmable
• Allows dose titration to give optimal benefit
• Effective in reducing spasticity
• Upper and lower extremities
• Cerebral and spinal origin

Goal of ITB Therapy

• Reduce spasticity that interferes with activity, care and comfort
• Facilitate rehabilitation therapies
• Improve function
• Improve ADLs
• Prevent spasticity related complications
• Pressure ulcers, contractures, pain
• Reduce caregiver burden
• Improve hygiene, transfers, catheterization

ITBTM Therapy Process

Stage 1: Patient Selection

Stage 2: Screening Test

Stage 3: Implant

Stage 4: Maintenance

How Does Baclofen Injection Work?

An Interdisciplinary Team Assesses the patient and

• Considers all facets of patient's needs and resources
• Considers the "whole" person
• Provides optimal care for the patient

Screening Test Flow Chart

Contraindications of ITB^TM Therapy

• Patient has a history of allergy (hypersensitivity) to oral baclofen
• Infection is present at time of screening or implant

Potential Risks of ITB^TM Therapy

• Common side effects: hypotonia, somnolence, nausea/vomiting, headache, dizziness
• Overdose, although rare, could lead to respiratory depression, loss of consciousness, reversible coma, and in extreme cases, may be life-threatening
• Catheter and procedural complications may occur

Causes of Overdose

• Dosing error
• Pump malfunction
• Programming error
• Injecting catheter access port during refill
• Filling catheter with syringe during surgery
• Use of concomitant drugs

Common Concerns

• OK to go through metal detectorsMay set off alarm – have ID card with you
• OK to have CT scan
• OK to have MRI (must interrogate pump afterwards)
• OK to continue stretching and activities
• OK to be near household appliances
• OK to scuba-dive (up to 10 meters