Advanced Intrathecal Baclofen Pump Therapy

Intrathecal baclofen (ITB) therapy uses an implantable programmable pump connected to a spinal catheter to deliver baclofen directly into the cerebrospinal fluid. Because the drug bypasses the blood-brain barrier, the required dose is approximately one-hundredth of the oral dose, achieving high local concentration in spinal GABA-B receptors with minimal systemic side effects.

ITB is indicated for severe spasticity that interferes with function, comfort, or care and has not responded to maximal oral therapy with baclofen, tizanidine, dantrolene, or to focal botulinum toxin injections. Common conditions include cerebral palsy, spinal cord injury, multiple sclerosis, traumatic brain injury, and stroke. Candidates undergo a screening trial of intrathecal baclofen via lumbar puncture to confirm response.

Pumps are implanted in the abdominal subcutaneous tissue, refilled every two to six months by transcutaneous needle, and adjusted by external programmer. Risks include catheter dysfunction, infection, withdrawal (life-threatening hyperthermia, rhabdomyolysis), and overdose (respiratory depression, coma). Comprehensive multidisciplinary follow-up with neurology, rehabilitation, neurosurgery, and pump-trained nursing is essential. ITB markedly reduces tone, improves seating, hygiene, sleep, and quality of life for severely affected patients.