Treating Spastic Cerebral Palsy with a Baclofen Pump

The drug baclofen (brand name Lioresal) is a medication that can be used to relax spastic muscles in people with cerebral palsy and other motor disorders. Baclofen can be administered transdermally (with a topical cream), orally (in a tablet form), or directly into the spinal fluid (intrathecal baclofen). The latter two means of administration are the most common.

Baclofen (Lioresal) is a muscle relaxant commonly used as an oral medication for the treatment of spasticity in children and adults with cerebral palsy. Baclofen can also be delivered through an intrathecal pump. This is a hockey puck-sized device that is implanted into the patient’s abdomen and continuously delivers the medicine into the fluid surrounding the spine.

There are several advantages to using an intrathecal baclofen pump for treating severe spasticity:

• ITB is typically more effective in controlling spasticity because it delivers medication directly to the spinal cord. With oral baclofen, the medication must first pass through other body systems such as the gastrointestinal system and the blood and can take a few hours to reach peak effectiveness.
• Because the pump delivers baclofen right where it is needed, people can take lower doses and experience fewer side effects.
• Baclofen has a very short half-life. Oral doses don’t allow for continuous delivery, while ITB does. This means that ITB allows for steadier spasticity relief.
• Unlike oral baclofen, you can program different doses throughout the day. This precision timing allows for greater flexibility in treating spasticity.
• ITB therapy is reversible. If you need therapy to be halted, the pump can be stopped and removed.

During surgery, the baclofen pump is placed under the skin of the patient’s abdomen. Once the pump is in place, the physician attaches a catheter to it. Then the physician threads the catheter under the skin at waist level and inserts it into the spinal canal. Next, the physician fills the pump with baclofen and sets it to deliver the exact amount of medicine the patient needs. The pump begins slowly releasing the medicine through the tube and into the spinal canal.

Baclofen pumps must be refilled with medicine every one to six months, depending on the patient’s dose. The pump lasts about five years. Afterward, it must be removed and replaced during another surgery due to wear and tear on the device.

Baclofen can be very effective at treating spasticity. However, there are some serious side effects of this drug. People who take oral baclofen are most likely to experience negative effects such as confusion, nausea, weakness, and tiredness. Use of an intrathecal pump minimizes most side effects, but there are also some potential dangers that are specific to the pump. These include:

• Unwanted movement of catheter or pump
• Skin over pump breaks down
• Infection or spinal fluid leak caused by surgery
• Pump or catheter failure leads to overdose or withdrawal symptoms (some of these are very serious, such as seizures, difficulty breathing, and organ failure)

These side effects should be weighed carefully when deciding whether to take intrathecal baclofen. Your doctor should be able to help you compare the potential risks and benefits.

Baclofen and baclofen pumps are effective in treating spasticity in many cases, provided that proper maintenance procedures and administration instructions are followed. We are including some additional information regarding baclofen pumps below for further information.

• The University of Michigan’s comprehensive guide to baclofen pumps
• The National Institute of Health: Intrathecal Baclofen Pump for Spasticity
• Cerebral palsy: Overview of management and prognosis on UptoDate

The information presented above is intended only to be a general educational resource. It is not intended to be (and should not be interpreted as) medical advice. If you have questions about intrathecal baclofen, please consult with a medical professional.