Baclofen Pump for Spasticity
The Intrathecal Baclofen Pump (ITB) is a device that delivers the muscle relaxant baclofen directly into the spinal fluid to effectively treat muscle spasticity in children with fewer side effects.
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Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, is a pioneer in functional neurosurgery, offering intrathecal baclofen pump therapy to treat muscle spasticity in children.
What is a baclofen pump?
A baclofen pump is a surgically implanted device, placed under the skin of the abdomen, to continuously deliver baclofen into the spinal canal, a fluid-filled space between the spinal cord and the vertebrae.
The baclofen pump consists of two parts:
• The pump: a circular metal disc that contains a battery, a drug reservoir, and a microprocessor.
• The catheter: a thin, flexible tube that carries the medication from the pump to the spinal fluid.
Dr. Zeiad Yossry programs the pump through a small computer that communicates with the microprocessor placed under the child's skin. This programming directs the pump to deliver the medication at the specified time. The medication reservoir is refilled periodically by inserting a needle into the pump and injecting the medication. Intrathecal baclofen pump relieves muscle spasticity that does not respond to conventional treatments.
What is baclofen?
Baclofen is a muscle relaxant that relieves symptoms of muscle spasticity by relaxing abnormally stiff muscles. Therefore, it is most often used to treat two types of abnormal muscle tone: stiffness and tightness. These conditions are common in patients with cerebral palsy, multiple sclerosis, and other brain and spinal cord injuries and diseases.
Delivering baclofen directly into the spinal fluid is more effective than oral intake and has fewer side effects. Within the spinal cord:
• Baclofen improves muscle movement, hyperactive reflexes, and excessive muscle tension.
• Baclofen reduces the frequency of the spasm.
Benefits of treating muscle stiffness with a baclofen pump for children:
• Effective relief of spasticity.
• Fewer side effects compared to oral baclofen (e.g., drowsiness, nausea, dizziness).
• Continuous drug delivery.
• A constant dose of medication to control symptoms continuously over 24 hours.
• Better muscle control, helping your child benefit more from physical, occupational, and speech therapy.
• Ability to program different doses at different times of the day to meet individual needs.
• Long-term control of muscle stiffness.
• Flexibility to stop treatment, if necessary, by turning off the pump or surgically removing the pump and catheter.
• Improved quality of life for your child and family.
Who is a suitable candidate for a baclofen pump?
Dr. Zeiad Yossry may recommend a baclofen pump for your child if he is experiencing severe muscle stiffness and oral medications have not been effective. During the consultation, he will assess whether a baclofen pump is a good option for him.
The evaluation begins with a trial injection of baclofen into the spinal fluid. Dr. Zeiad Yossry first injects a small test dose to assess effectiveness. The medical team then evaluates the effects over several hours. The response typically begins within 60 minutes, peaks after about four hours, and lasts for 8–12 hours. By the following day, the test dose is usually eliminated from the body.
Although the effects of the trial dose are temporary, this dose provides valuable information to aid decision-making. If the symptoms of muscle stiffness improve, the child will likely benefit from regular doses of baclofen from an implantable pump.
Details of baclofen pump surgery:
On the day of surgery, your child will receive general anesthesia to ensure he feels no pain and remains asleep during the procedure. Dr. Zeiad Yossry will perform the following steps:
1. Implantation Surgery: Dr. Zeiad Yossry implants the pump under the skin of the abdomen, then connects one end of the catheter to the pump. He also makes a small incision in your child's back to place the other end of the catheter into the spinal fluid. Finally, both incisions are closed.
2. Filling the pump: The pump is then filled with baclofen either during or after surgery.
3. Surgery duration: The surgery can take up to two hours. After the surgery, the child will stay in the hospital for a short period.
4. Programming: The pump is programmed using a computer to deliver a specific dose of baclofen throughout the day.
4. Programming: The pump is programmed using a computer to deliver a specific dose of baclofen throughout the day.
5. Follow-up visits: Dr. Zeiad Yossry’s medical team schedules regular follow-ups to adjust baclofen doses as needed. These visits are also important for evaluating symptoms and tracking progress.
Baclofen pump position for treating muscle stiffness in children:
The most common site for a baclofen pump is under the abdominal skin, near the navel. Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, determines the optimal placement based on the child's age, body type, and overall health.
All about the baclofen pump:
• In the early stages of treatment, your child will visit our clinic every one to two weeks for pump checks and dose adjustments. A magnetic programmer is used to adjust the dosage and timing of medication administration. As symptoms improve, follow-up visits will become less frequent. During these visits, the pump is refilled and the dose/timing adjusted to suit your child’s needs.
• Dr. Zeiad Yossry educates parents about the device so they are aware of how it works and how to maintain it to avoid baclofen withdrawal symptoms. These symptoms occur if baclofen delivery through the pump or catheter is interrupted. These symptoms include severe muscle stiffness or spasms, itchy skin without a rash, severe discomfort or pain, sweating, low-grade fever, dizziness, nausea, and seizures.
• The pump must be refilled regularly (usually every one to six months, depending on the dose) by inserting a needle into the refill port to prevent the reservoir from running out of baclofen and avoid withdrawal symptoms.
• The dose of baclofen can be adjusted at any time.
• When the pump battery expires, it must be replaced (but not the catheter).
• If there is a problem with the baclofen pump or catheter, they may need to be surgically replaced or repositioned.
• Seek medical attention as soon as possible if you suspect that the pump is not working properly.
How long does a baclofen pump battery last?
The baclofen pump battery typically lasts six to seven years, although this duration may vary from person to person.
Your child will need another surgery to replace the pump before the battery runs out. This procedure is usually faster than the initial implantation because the catheter is already in place, and in most cases, you'll be able to go home the same day.
Baclofen pump therapy is a safe and effective long-term treatment designed to improve the quality of life of children with chronic spasticity. Thanks to Dr. Zeiad Yossry's expertise in functional neurosurgery, patients can achieve accurate and safe results and regain their daily independence.
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