Adult Intrathecal Baclofen (ITB) service and Referral pathway
The Aim of our service is:
Functional/Symptomatic Improvement in adults with spasticity of cranial or spinal origin using ITB and smooth transition of paediatric patients into adult ITB service for ongoing care.
The goals for our service are:
- All adults needing spasticity management can be referred to our service for input
- ITB therapy is considered, if deemed suitable
- Dosing of ITB will be directed by patient-centered goals
Key people within the service:
Dr Kanch Devinuwara(ITB service clinical lead, Consultant Rehabilitation Medicine) Manoj Sivan (Associate Professor Rehabilitation Medicine)
Mr G.Sivakumar (ITB service Consultant Neurosurgeon) 0113 3928567
Jenny Jennings (Lead Clinical Nurse Specialist mob: 07766360404 or 01133922178 Monday to Friday 8:00am to 4:00pm)
Other Clinical Nurse Specialists: Mayona Raneses-Jeffrey, Karen Robertson.
Ryan Hurst (specialist physiotherapist) 0113 3922720
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 | Generalised 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 [email protected]
- All referrals that are not GP or internal referrals must go to [email protected]
These will be sent to the Complex Neuro Rehab consultants for Triage. Patients will then receive an appointment within six weeks or the referrer will be given advice if the referral is not accepted or redirected.