Introduction - ITB pumps
Why?
Intrathecal Baclofen is a useful treatment option in carefully selected patients who have chronic resistant spasticity or dystonia that have exhausted other treatment modalities. Spasticity is the involuntary, velocity-dependent, resistance to movement of a muscle. Dystonia refers to involuntary muscle contractions leading to abnormal movements and postures. Both spasticity and dystonia are common complications of damage or abnormality of the brain/spinal cord.
Baclofen is a muscle relaxant which can be given orally or intrathecally. When given intrathecally, Baclofen doses required for a similar effect to oral doses is 100 x lower. Current ITB pumps offer a significant amount of flexibility in dosing regimens allowing us to tailor treatment regimens to the individual’s specific needs.
Patient Selection
|
Indication |
Generalized spasticity or dystonia which negatively affects function, quality of life or care provision. Less invasive management options have been tried already or not tolerated. |
|
Contra-indications |
Definite history of allergic reaction to oral Baclofen/ ITB test dose |
|
Relative contra-indications |
Concerns regarding ability to tolerate general anaesthetic or medical instability. Untreated hydrocephalus (poor absorption of intrathecal Baclofen and increased risk of CSF leak).Poorly controlled epilepsy, coagulation disorders, malnutrition (increased risk of post-surgical complications/healing).Negative impact on function with ITB. Spinal abnormalities/surgery that may make surgery difficult. Recent CNS infection. Concerns regarding patient’s ability to attend regular appointments or to respond in an urgent manner to emergency situations (i.e. drug withdrawal and overdose symptoms). Thick Soft tissue/adipose layer. Skin pressure ulcers |
Referral pathway for ITB
- All GP practices must use the Choose and Book service ( Search Complex Neuro Rehab)
- Internal consultant to consultant referrals must be sent to the following email account leedsth-tr.GP-Referrals@nhs.net
- All referrals that are not GP or internal referrals must go to lthtreferrals@nhs.net
These will be sent to the Complex Neuro Rehab consultants for Triage. Patients will then receive an appointment within 6 weeks or the referrer will be given advice if the referral is not accepted or redirected.
Standard Operating Procedure
