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Intrathecal
baclofen has gained a steady foothold in the management of spasticity
in adults and children over the past two decades. Although the
origin of the spasticity differs in both groups, the result is
the same - muscle tightness, pain, deformity and an impact on general quality of
life. These problems are usually addressed by oral spasticity
medication, but the spasticity may become uncontrollable.
As technology moved on in the 1980's, it became possible to manufacture
and implant systems that can accurately deliver drugs, in this
case baclofen, into the nervous system. By delivering baclofen
directly into the nervous system the often severe side-effects
of oral medication can be avoided and the dose needed to obtain
a comparable or better effect on spasticity than the oral medication
is up to 100 times smaller.
An implant for ITB can only be decided when the patient has severe
spasticity, which impacts on quality of life. The patient needs
a test procedure, whereby a limited dose of baclofen is injected
into the spinal fluid to assess the clinical effect. After the
test procedure, the risks and benefits of the implant are discussed
and a joint decision whether or not to implant is made by the
patient/ carer and the medical team. After the implant procedure,
the system will need refilling periodically (usually at intervals
between 2-6 months) as the drug reservoir's volume is limited.
In addition, although the batteries have a long lifespan, the
pump will require replacing after several years.
Intrathecal baclofen implants are safe. There are a number of
adverse events, the most serious one being infection of the system,
but serious life threatening events are very rare. The benefits
of ITB and the improvement in quality of life can by far outweigh
the risks of having the device implanted.
For more than 50 years, Medtronic® has pioneered the development
of implantable products and therapies designed to alleviate pain,
restore health and extend life, bringing hope to thousands of
patients worldwide. Medtronic made its commercial debut in implantable
drug delivery systems in 1988 with the SynchroMed® Infusion
System which has now evolved and developed into the current SynchroMed
II Infusion pump system family of fully implantable programmable
pumps. The arrival of the SynchroMed pump established Medtronic
as the leader in site-specific drug delivery for the management
of severe spasticity. |
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