Spasticity management with multiple sclerosis, stroke, spinal cord injury and other neurological issues
Wednesday, October 22, 2014
Spasticity, the abnormal increase in muscle tone or tightness, affects nearly half a million people in the US. Spastic muscles are resistant to regular stretching and often remain contracted throughout a person’s lifetime. Spasticity from multiple sclerosis (MS), stroke, spinal cord injury or other neurological disorders can affect a single limb, upper or lower body regions or the body as a whole. If a patient is affected in more than one area or across his or her entire body, baclofen is regularly prescribed for spasticity management.
Baclofen is often prescribed to treat MS, along with spinal cord injuries and other neurological diseases. While effective, baclofen does have one drawback – it has difficulty penetrating the blood/brain barrier to enter the spinal fluid. Additionally this medication is somewhat sedative and can cause confusion and weakness; if a patient takes a high dose or takes the medication orally, they may see improvement but the side effects may outweigh any positive results.
A more effective means of administering the medication is by an intrathecal pump. This is where a small pump is placed inside a person which delivers baclofen directly into the spinal fluid. This system consists of a pump –a small (approximately one inch by three inch) round metal disc surgically inserted under the patient’s skin near the waistline -- and a catheter tube which leads to the fluid surrounding the spinal cord. If the patient responds well to the trial the device will be permanently implanted. There are several advantages to using a baclofen pump system:
- Continuously delivers baclofen directly to the spinal fluid, which increases benefits and reduces side effects.
- Can be adjusted to each individual; infusion rates can vary over a 24 hour period.
- Effectively reduces spasticity, which allows for a more active way of life.
- Relieves pain from spasms and spasticity.
- Reduces the need for oral medications.
An external programmer is used to make any adjustments to the rate, timing and dosage of the medication. The pump will need to be refilled every third or fourth month depending upon the situation. Additionally, the pump’s battery lasts up to seven years, at which time it would need to be replaced. The majority of our patients benefit from the baclofen pump trial. Diagnosis and preliminary trial results will determine if a patient is a good candidate for a permanent device. If you think you may be a good candidate for the baclofen pump trial, contact our office at (920) 288-8377.
Danzhu Guo, MD, is a Board Certified physiatrist at BayCare Clinic Pain & Rehab Medicine. He has special interests in neurological disorders, occupational health, orthopedics, sports medicine and injury, trauma, chronic pain management and spasticity management. He received his medical education at the Fourth Military Medical University in Xi’an, China, and completed his residency in Physical Medicine and Rehabilitation at the University of Kentucky Medical Center. Learn more here.