Intrathecal Baclofen Pump

An intrathecal baclofen pump is a means of delivering the medication, baclofen, into the cerebral spinal fluid (CSF) around the spinal cord. A small, battery-powered device is inserted normally in the abdomen and is connected via a small flexible silicone tube to the intrathecal space so that the medication, baclofen, can act directly on the spinal cord.

Baclofen is a gamma-aminobutyric acid (GABA) agonist and this means it acts to reduce the release of chemicals, or excitatory neurotransmitters, from the spinal cord which cause muscle spasticity. Baclofen can be delivered continuously through a pump to keep the release of these chemicals reduced around the clock.

An intrathecal baclofen pump has multiple benefits.  The medication itself works to reduce spasticity and so can reduce the pain and discomfort associated with spasticity and improve how a person with cerebral palsy moves. When baclofen is given by mouth, it is not able to reach the CSF as directly as medication given through the baclofen pump. This means that the effect baclofen has when taken orally is much less. Higher doses are therefore used when it is given by mouth and so there is also more potential for someone with cerebral palsy to suffer from side effects including sedation, drowsiness and headache.

The tube positioned in the CSF allows for the medication to be delivered continuously to the area of the spinal cord which is most likely to be responsible for the spasticity, and so an intrathecal baclofen pump can continuously and more effectively reduce muscle spasms, pain and spasticity. The dose of baclofen released from the pump can also be altered according to how a person responds to the medication.

Baclofen delivered via an intrathecal pump can still cause side effects such as sedation, drowsiness and headache, although the risk is less than when given by mouth. There are also risks as a result of having the pump and tube inserted surgically. Around a fifth of those inserted with a baclofen pump experience a complication including infection, the tube moving or becoming disconnected, the pump failing or a CSF fluid leak from the intrathecal space and headache. These complications can be treated and the pump itself can be removed if necessary. Rarely, when baclofen is stopped it can cause a withdrawal reaction which can be severe and will require admission to hospital.

In order to determine if your child will benefit from baclofen therapy you should speak with your child’s pediatrician or physiatrist. A child will need to be assessed for suitability, and their suitability may depend upon the degree of spasticity in their legs and how their cerebral palsy otherwise impacts upon their health and movement. Intrathecal baclofen pumps are usually covered by government health insurance plans, including MSP.