COLUMBUS, Ohio – When a person’s muscles miscommunicate because of a central nervous system disorder, the result can be spasticity – an often painful condition that interferes with balance and many normal functions, such as walking, eating or getting dressed, or even being able to sit properly in a wheelchair. The condition is associated with such diseases as multiple sclerosis and cerebral palsy as well as stroke, spinal cord injury or trauma to the brain.
Albert C Clairmont, M.D.
Increasing numbers of patients with spasticity are finding relief from a device called an intrathecal baclofen pump, an implanted disk-shaped device that delivers a powerful muscle relaxant directly to cerebrospinal fluid that surrounds the spinal cord, speeding the drug’s ability to ease muscle contractions.
“Because medicine is delivered directly to where it’s needed, one can use less of the medicine to get better relief of spasticity,” said Dr. Albert Clairmont, a physical medicine and rehabilitation specialist at The Ohio State University Medical Center. “Patients can get the functional gains and relief from tightness and pain without the side effects that can come with an oral medication.”
In fact, the pump’s targeted delivery means the dose to the spinal cord is 100 times lower than an oral dose treating the same condition, Clairmont said. The most common side effects with an oral dose of baclofen are drowsiness and mental slowness.
“If one has to take a large dose of baclofen by mouth to get some looseness in the muscles, there is a much higher probability that the patient will suffer those side effects, which can interfere with being able to work,” Clairmont said.
The pump itself is contained in a titanium disk placed in tissue under the skin in front of the abdomen. A catheter carrying medication from the pump is tunneled toward the patient’s back and is implanted into the spinal canal, or intrathecal area of the spine.
“The pump is essentially a little computer that gets the fluid moving,” said Clairmont, who is currently monitoring about 100 patients with implanted pumps. A hand-held device programs the pump to deliver the proper dose of baclofen throughout the day, or additional baclofen at specific times of day. The medication can be refilled through a syringe injected through the skin into the pump.
For years, the treatment approach for patients with spasticity focused on starting with the simplest techniques, such as physical therapy and oral muscle relaxants, before moving on to more invasive treatments, such as injections of chemicals that affect muscles and nerves and implantation of a baclofen pump.
“The thoughts have changed a bit,” Clairmont said. “We now know that some people will respond well to oral medication, but some people need a multifaceted approach to manage their spasticity. So we plan a program that will work for each person.”
For example, the pump’s consistent drug delivery may be supplemented by targeted injections of therapeutic agents such as Botox or phenol to weaken particularly stiff muscles.
“For people with these upper motor neural problems, the muscles can literally fight each other. Opposing groups of muscles normally contract and relax for smooth movement, but with spasticity, opposing muscles contract at the same time, which really messes up coordinated movement,” Clairmont said. “It really affects a wide spectrum of patients, and this more aggressive intervention is proving to be very helpful.”
The intrathecal baclofen pump is manufactured by Minneapolis-based Medtronic Inc.# # #
Medical Center Communications