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 ITBTM 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 ITBTM Therapy

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

Potential Risks of ITBTM 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
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