Baclofen pump: how it aids severe spasticity

Written by: Mr Sanj Bassi
Published: | Updated: 15/11/2018
Edited by: Laura Burgess

A Baclofen pump is an implant used to treat involuntary muscle spasms (dystonia) and stiff or rigid muscles (severe spasticity). Mr Sanji Bassi, a neurosurgeon at the London Neurosurgery Partnership, explains how it works in bringing spasm relief to cases of cerebral palsy, multiple sclerosis and other nerve diseases…


Why would someone need to use the Baclofen pump?

As neurosurgeons, we see a wide variety of patients with different symptoms and diagnoses. In my practice, I often see individuals with conditions such a cerebral palsy and increased spasticity. Spasticity can be quite disabling and have a significant impact on quality of life.

Anything that causes damage to part of the brain can increase spasticities such as cerebral palsy, stroke, head injury and multiple sclerosis. Increased spasticity causes the muscles to go into spasm which can be extremely painful and quite distressing for the individual. Left untreated the increased muscle spasms can have a considerable impact on daily activities including walking and using arms and legs.
 

What is Baclofen exactly?

In the treatment of these individuals, there may be the option of implanting an intrathecal Baclofen pump, which delivers a drug directly to the fluid around the brain and spine. This drug is known as Baclofen, which is a relative of Diazepam and works as a muscle relaxant. In fact, it is known as a Gaba (neurotransmitter) agonist which provides negative (inhibitory) impulses to the muscles thus relaxing them.
 

How is Baclofen taken?

Baclofen can be taken by the mouth, however, only a small amount of the drug will go into the brain and spine and therefore oral Baclofen has quite limited benefits. If the dose of Baclofen is increased enough to improve the spasticity significantly, patients, unfortunately, suffer many side effects of the drug such as sleepiness and drowsiness.

Since 1998 it has been possible to deliver Baclofen directly into the brain and spine at a dose that is 1000 times less than that taken by mouth. This tiny dose of Baclofen is very effective in relieving spasticity and has none of the side effects of the oral version of the drug.

 

How does the Baclofen pump work?

The drug is delivered through a small pump which is the size of an iPhone 5. This pump is implanted in the fat of the tummy and a small tube (about the thickness of a pencil lead) is run from the pump into the spine. The operation to implant these is quite straightforward. The pump is then programmed by Bluetooth to deliver the drug continuously to the brain and spine thus improving the spasticity. The dosage can be changed and increased using the Bluetooth device.

 

What’s the shelf-life of a Baclofen pump?

The pump usually holds enough drug for about 4 months of treatment and then has to be refilled with the drug using a small needle. The refilling of the pump is probably very similar to having blood taken. These pumps have a limited battery life and usually need to be changed every 8 years.

By Mr Sanj Bassi
Neurosurgery

Mr Sanj Bassi is a London-based Neurosurgeon who has an interest in both adult and paediatric neurosurgery. He practises at various clinics in the capital including the Bupa Cromwell hospital and the London Neurosurgery Partnership.

Mr Sanj Bassi treats a wide range of conditions including brain tumours, brain haemorrhages, hydrocephalus, chiari malformations and facial pain, as well as spinal problems including sciatica, back pain, spinal claudication and spinal stenosis. Outside of his clinic he is dedicated to research and has been widely published in leading peer-reviewed journals and forms an integral part of various professional bodies such as the Royal College of Surgeons.

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