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A baclofen pump is a device that delivers a medication called baclofen to the spinal canal. The baclofen pump is surgically implanted near the abdomen, with a catheter (a thin flexible tube) running to the spinal canal to deliver the medication. Treatment with a baclofen pump is also called intrathecal baclofen therapy (ITB).
Baclofen is one of the most effective medications for spasticity (involuntary muscle contractions that cause stiffness) and dystonia (muscle contractions that can result in twisted or abnormal postures). These movement disorders often accompany conditions such as cerebral palsy, leukodystrophy, and multiple sclerosis.
Spasticity and dystonia in children who have cerebral palsy, leukodystrophy or multiple sclerosis can interfere with the development of motor skills and may, over time, cause permanent problems as muscles weaken and contractions distort posture.
Baclofen acts on the spinal cord to suppress abnormal nerve signals that trigger the muscle contractions of spasticity and dystonia and to restore normal nerve signals. Baclofen can be taken orally, in pill form, or delivered directly into the spinal fluid using an intrathecal baclofen pump, an implanted, battery-powered medical device. Intrathecal refers to the spinal canal, or theca.
Children with severe spasticity or dystonia whose symptoms are not helped by oral baclofen, or who have side effects from baclofen pills when taken at the doses needed to control their symptoms, may be as candidates for a baclofen pump.
By delivering baclofen directly to the spinal fluid, the baclofen pump can be effective in controlling spasticity and dystonia at doses 100 times lower than baclofen pills.
The baclofen pump is implanted using a surgical procedure performed while your child is under general anesthesia.
The pump is a round metallic disc, about 3 inches across and 1 inch thick. It is typically placed just beneath the skin of the abdomen, to the left or right of the belly button. The catheter to deliver the medication into the spinal fluid is fed from the pump to the point near the spine or in the brain where the dosage of baclofen will most effectively address your child’s symptoms.
Before surgery to implant the device, your child will be treated with one test dose of baclofen injected into the spinal fluid, or with a continuous infusion using an external pump. These test injections will be administered by a trained nurse in the hospital, and your child will be kept overnight for observation.
The test doses allow the doctor to see how your child’s movement symptoms are affected by the medication and whether there are any negative side effects.
On the day of the surgery, you child will undergo general anesthesia. At Children’s Hospital of Philadelphia (CHOP), you can trust our specially trained pediatric anesthesiologists to keep your child comfortable and safe before, during and after their procedure. Read more about our dedicated pediatric anesthesiology team.
The surgery itself usually takes about two hours.
Your child will remain at the hospital for one to seven days for observation and post-surgical therapy.
While your child is at the hospital, the medical team may make initial adjustments to the dose of medication to control your child’s movement symptoms, and will watch for any negative side effects. The baclofen pump is controlled by a remote computerized device, using a wand placed over the skin.
Physical and occupational therapists may begin to work with your child on improving their range of motion, and decreasing spastic and/or dystonic movements that they may not have had before the baclofen treatment. You and your child will learn how to continue these exercises at home.
Before your child is released to go home, your medical team will review what you need to know about managing the pump, caring for the incision while it heals, recognizing the signs of baclofen withdrawal or overdose, and what activities should be encouraged or avoided in the first few weeks. Arrangements may be made for local physical and occupational therapist to come to your home.
You will be asked to bring your child back for regular follow-up visits to assess progress, adjust the medication dosage, and refill the pump with baclofen as needed. The pump is refilled every one to six months by inserting a needle through the skin into a refill port on the pump.
It may take several weeks or a few months to get to the optimal dose levels and schedule. Changes to the baclofen doses are made gradually, with careful monitoring of the results.
Once the optimum dose is found, the pump can be programmed to vary the dose at different times of day or for specific activities.
It will be important to maintain the pump and monitor its supply of baclofen to avoid lapses in medication, which can lead to withdrawal systems. You will be expected to bring your child to all scheduled medical appointments, and to keep a supply of oral baclofen on hand in case of an unexpected interruption in the pump’s delivery of medication.
The pump will likely be visible as a small protrusion in the skin and may be visible under close-fitting clothes.
At Children’s Hospital of Philadelphia (CHOP), our Division of Neurosurgery works closely with the interdisciplinary Cerebral Palsy Program and Leukodystrophy Center to ensure that candidates are screened appropriately for a baclofen pump implant, and to provide the full range of supportive therapy before and after surgery in order to optimize outcomes.
Your child will have access to a broad team of specialists with expertise in every element of the care of children with cerebral palsy, who are committed to staying abreast of the latest technology available and innovative approaches to both surgical and medical treatment.