Advertisement

Intrathecal Medication Administration in Cerebral Palsy

  • Julieanne P. SeesEmail author
  • Freeman Miller
Living reference work entry

Abstract

Administering medication directly into the intrathecal space, especially in the spinal canal, has continued to be of interest. A drug concentrated in this region of the nervous system should provide the most direct effect. The current administration of intrathecal baclofen has been used for this reason by means of a battery powered pump implant is placed in the abdomen and an intrathecal catheter is introduced into the intrathecal space within the spine. The pump is controlled with an external radiowave-mediated controller, and the pump reservoir is filled by direct injection through the overlying skin. The administration may be continuous or the pump can be programmed to have higher doses over a short time and utilized a flexible dosing regimen as desired. Rare potential side effects have been reported including infection, catheter malfunction, and weakness uncovered with reduction in spasticity. The treatment of intrathecal infusion of baclofen is widely beneficial in the management of movement disorders, severe spasticity, enhancement of range of motion, increase in motor function and mobility, alleviating discomfort, and aid in overall care whether used stand alone and/or in conjunction with common modalities of pharmacology agents, physical therapy, and orthopedic surgery for nonambulatory and ambulatory patients with cerebral palsy.

Keywords

Intrathecal baclofen pump ITB Intrathecal medication administration Antispasticity medication Movement disorder management 

References

  1. Abousamra O, Rogers KJ, McManus M, Miller F, Sees JP (2016) Evaluation of intrathecal baclofen delivery system malfunction by computed tomography scan. Dev Med Child Neurol 58:409–415CrossRefGoogle Scholar
  2. Abousamra O, Duque Oroszo MdP, Rogers KJ, Miller F, Sees JP (2017) Infections of intrathecal baclofen delivery systems and ventriculoperitoneal shunting systems: clinical series discussion. Pediatr Neurosurg [Epub ahead of print]Google Scholar
  3. Agmo A, Paredes R (1985) GABAergic drugs and sexual behavior in the male rat. Eur J Pharmacol 112:371–378CrossRefGoogle Scholar
  4. Albright AL (1996a) Baclofen in the treatment of cerebral palsy. J Child Neurol 11:77–83CrossRefGoogle Scholar
  5. Albright AL (1996b) Intrathecal baclofen in cerebral palsy movement disorders. J Child Neurol 11(Suppl 1):S29–S35CrossRefGoogle Scholar
  6. Albright AL, Cervi A, Singletary J (1991) Intrathecal baclofen for spasticity in cerebral palsy. JAMA 265:1418–1422CrossRefGoogle Scholar
  7. Albright AL, Barry MJ, Fasick P, Barron W, Shultz B (1996) Continuous intrathecal baclofen infusion for symptomatic generalized dystonia. Neurosurgery 38:934–938; discussion 938–939CrossRefGoogle Scholar
  8. Almeida GL, Campbell SK, Girolami GL, Penn RD, Corcos DM (1997) Multidimensional assessment of motor function in a child with cerebral palsy following intrathecal administration of baclofen. Phys Ther 77:751–764CrossRefGoogle Scholar
  9. Armstrong RW, Steinbok P, Cochrane DD, Kube SD, Fife SE, Farrell K (1997) Intrathecally administered baclofen for treatment of children with spasticity of cerebral origin. J Neurosurg 87:409–414CrossRefGoogle Scholar
  10. Bayham IA, Sees JP, Nishnianidze T, Rogers KJ, Miller F (2016) Infection as a complication of intrathecal baclofen treatment in children with cerebral palsy. J Pediatr Orthop 36:305–309CrossRefGoogle Scholar
  11. Bennett MI, Tai YM, Symonds JM (1994) Staphylococcal meningitis following synchromed intrathecal pump implant: a case report. Pain 56:243–244CrossRefGoogle Scholar
  12. Boster A, Bennett S, Bilsky G, Gudesblatt M, Koelbel S, McManus M, Saulino M (2016) Best practices for intrathecal baclofen therapy: screening test. Neuromodulation 19:616–622CrossRefGoogle Scholar
  13. De Lissovoy G, Matza L, Green H, Werner M, Edgar T (2007) Cost-effectiveness of intrathecal baclofen therapy for the treatment of severe spasticity associated with cerebral palsy. J Child Neurol 22:49–59CrossRefGoogle Scholar
  14. Denys P, Mane M, Azouvi P, Chartier-Kastler E, Thiebaut JB, Bussel B (1998) Side effects of chronic intrathecal baclofen on erection and ejaculation in patients with spinal cord lesions. Arch Phys Med Rehabil 79:494–496CrossRefGoogle Scholar
  15. Erickson DL, Blacklock JB, Michaelson M, Sperling KB, Lo JN (1985) Control of spasticity by implantable continuous flow morphine pump. Neurosurgery 16:215–217CrossRefGoogle Scholar
  16. Gerszten PC, Albright AL, Barry MJ (1997) Effect on ambulation of continuous intrathecal baclofen infusion. Pediatr Neurosurg 27:40–44CrossRefGoogle Scholar
  17. Kita M, Goodkin DE (2000) Drugs used to treat spasticity. Drugs 59:487–495CrossRefGoogle Scholar
  18. Kraus T, Gegenleitner K, Svehlik M, Novak M, Steinwender G, Singer G (2017) Long-term therapy with intratethecal baclofen improves quality of life in children with severe spastic cerebral palsy. Eur J Paediatr Neurol 21:565–569CrossRefGoogle Scholar
  19. Leipheimer RE, Sachs BD (1988) GABAergic regulation of penile reflexes and copulation in rats. Physiol Behav 42:351–357CrossRefGoogle Scholar
  20. McLaughlin JF, Bjornson KF, Astley SJ et al (1998) Selective dorsal rhizotomy: efficacy and safety in an investigator-masked randomized clinical trial. Dev Med Child Neurol 40:220–232CrossRefGoogle Scholar
  21. Pruszczynski B, Sees J, Hulbert R, Church C, Henley J, Niiler T, Miller F (2017) The effect of continuous intrathecal baclofen therapy on ambulatory children with cerebral palsy. J Pediatr Orthop B [Epub ahead of print]Google Scholar
  22. Rode G, Mertens P, Beneton C, Schmitt M, Boisson D (1999) Regression of vasomotor disorders under intrathecal baclofen in a case of spastic paraplegia. Spinal Cord 37:370–372CrossRefGoogle Scholar
  23. Saulino M, Guillemette S, Leier J, Hinnenthal J (2015) Medical cost impact in intrathecal baclofen therapy for severe spasticity. Neuromodulation 18:141–149CrossRefGoogle Scholar
  24. Saulino M, Anderson D, Doble J, Farid R, Gul F, Konrad P, Boster A (2016) Best practices for intrathecal baclofen therapy: troubleshooting. Neuromodulation 19:632–641CrossRefGoogle Scholar
  25. Steinbok P, Reiner AM, Beauchamp R, Armstrong RW, Cochrane DD, Kestle J (1997) A randomized clinical trial to compare selective posterior rhizotomy plus physiotherapy with physiotherapy alone in children with spastic diplegic cerebral palsy [published erratum appears in Dev Med Child Neurol 1997;39(11): inside back cover]. Dev Med Child Neurol 39:178–84Google Scholar
  26. Sweet CS, Wenger HC, Gross DM (1979) Central antihypertensive properties of muscimol and related gamma-aminobutyric acid agonists and the interaction of muscimol with baroreceptor reflexes. Can J Physiol Pharmacol 57:600–605CrossRefGoogle Scholar
  27. Wiens HD (1998) Spasticity in children with cerebral palsy: a retrospective review of the effects of intrathecal baclofen. Issues Compr Pediatr Nurs 21:49–61CrossRefGoogle Scholar
  28. Zierski J, Muller H, Dralle D, Wurdinger T (1988) Implanted pump systems for treatment of spasticity. Acta Neurochir Suppl 43:94–99PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Nemours Alfred I. DuPont Hospital for ChildrenWilmingtonUSA

Section editors and affiliations

  • Freeman Miller
    • 1
  1. 1.AI DuPont Hospital for ChildrenWilmingtonUSA

Personalised recommendations