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 What is Spasticity? Spasticity is an increase in muscle tone with uncontrolled, repeated spasms (Involuntary flexing of the skeletal muscles, These spasms occur when the muscles resist being stretched, Spasms are common in children with brain or spinal cord injury. What is baclofen? Baclofen is a muscle relaxant medication, It is commonly used in adults to decrease spasticity related to spinal cord injuries or multiple sclerosis, Baclofen is also used to treat children who have cerebral palsy. How does baclofen work? Spasticity is caused by an imbalance of excitatory and inhibitory input in the spinal cord. This imbalance causes hyperactive muscle stretch reflexes. These reflexes result in involuntary spasms and increased muscle tone. Baclofen works by blocking the release of excitatory neurotransmitters in the spinal cord, Ideally, baclofen restores the balance of excitatory and inhibitory input to reduce muscle hyperactivity, In this way, it also allows more normal motor movements.
The baclofen pump system is the intrathecal (directly into the spinal fluid) method of delivering the medication. The system consists of a catheter (a small, flexible tube) and a pump. The pump--a round metal disc, about one inch thick and three inches in diameter--is surgically placed under the skin at the level of the abdomen. The pump stores and releases prescribed amounts of medication through the catheter. The pump has a 1 O-mL fluid capacity and can be refilled by inserting a needle through the skin into a filling port (called the diaphragm) in the center of the pump. Who is a candidate for the pump system? Anyone who has spasticity and weighs over 30 pounds can be considered for the baclofen pump system. The pump system is appropriate when adjustable and potentially reversible treatment is desired, but cannot be achieved with oral medication. Your child may benefit from a baclofen pump if he or she has:
The pump is surgically placed just underneath the skin, usually in the lower abdominal area. A spinal tap (lumbar Puncture) is performed through a small incision in the lower back. A small tube is threaded into the spinal column while the other end of the catheter is guided towards the abdomen where it is connected to the pump. The procedure to place the pump lasts from 2 to 3 hours. In the future, your child will need antibiotics before having dental work or other invasive procedures. Your child should also wait two weeks before getting any immunizations. While the pump is in place your child should avoid:
With a programmable pump, a tiny motor moves the medication from the pump reservoir through the catheter. Baclofen flows freely through the spinal fluid, affecting the nerves to control muscle hyperactivity. Adjustments in the dose, rate, and timing of the medication can be made by your doctor, using an external programmer. The pump system can be set to dispense medication continuously or at certain times of the day. The pump can also be easily reprogrammed if necessary. Patients must return to their doctor's office for pump refills and medication adjustments, typically every 2 to 3 months. The pump system is taken out and replaced at the end of the battery's life span (which is usually 3 to 5 years). When To Call Your Surgeon The catheter may become clogged, disconnected or infected. If this happens, your child may experience:
Whenever you have a question or a concern you should call your doctor at Childhood Neurosurgery and Center for Hydrocephalus for further evaluation. SELECTIVE DORSAL RHIZOTOMY Selective dorsal rhizotomy is a treatment for spasticity that involves the sectioning of certain nerve rootlets to reduce tone. Monitoring of the responses to stimulation is performed in the operating room and the operation can improve ambulatory potential in certain children. A team approach is utilized involving the input of orthopedic surgeons, neurologists, physical and occupational therapists with an interest in spasticity and movement disorders. |
