Intrathecal Baclofen Pump Therapy for Multiple Sclerosis (MS)

  • Medical Author:
    Danette C. Taylor, DO, MS, FACN

    Dr. Taylor has a passion for treating patients as individuals. In practice since 1994, she has a wide range of experience in treating patients with many types of movement disorders and dementias. In addition to patient care, she is actively involved in the training of residents and medical students, and has been both primary and secondary investigator in numerous research studies through the years. She is a Clinical Assistant Professor at Michigan State University's College of Osteopathic Medicine (Department of Neurology and Ophthalmology). She graduated with a BS degree from Alma College, and an MS (biomechanics) from Michigan State University. She received her medical degree from Michigan State University College of Osteopathic Medicine. Her internship and residency were completed at Botsford General Hospital. Additionally, she completed a fellowship in movement disorders with Dr. Peter LeWitt. She has been named a fellow of the American College of Neuropsychiatrists. She is board-certified in neurology by the American Osteopathic Board of Neurology and Psychiatry. She has authored several articles and lectured extensively; she continues to write questions for two national medical boards. Dr. Taylor is a member of the Medical and Scientific Advisory Council (MSAC) of the Alzheimer's Association of Michigan, and is a reviewer for the journal Clinical Neuropharmacology.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

The Effects of Multiple Sclerosis

What is multiple sclerosis (MS)?

Multiple sclerosis (MS) is a disease that causes demyelination of the brain and spinal cord, or a loss of the protective covering around nerve fibers called axons. When this occurs, the axons (the parts of the nerve cells that transmit impulses to other cells) don't work well. As more areas are affected by the loss of myelin, different symptoms develop. The specific symptoms seen in MS are related to the area of injury in the brain or spinal cord. Patients might experience or describe numbness, tingling, or weakness. The weakness might be mild or severe enough to cause paralysis of one side of the body. In some cases, patients may develop loss of control of their bladder or an inability to empty their bladder. As MS progresses, some patients are left with muscle spasticity, which is an involuntary painful contraction of some muscles.

What is spasticity?

Spasticity is a condition in which muscles are exhibiting almost constant contracture or activity, leading to loss of range of motion, decreased function, and even pain. Spasticity occurs after an area of the brain or spinal cord has been injured, leading to weakness and increased tone. When an arm or leg that is affected by spasticity is moved by a health-care professional, there is involuntary resistance to that movement. Often, this spasticity is made worse when the speed (or velocity) of the movement increases. Spasticity is often seen in association with a brain injury, such as after:

  • a stroke,
  • traumatic damage to the brain or spinal cord, or
  • in cases of MS.

What is baclofen, and what are its side effects?

Baclofen is a medication that works in the brain to decrease uninhibited signals that start in an injured area of the brain and cause spasticity. By decreasing these signals, the affected muscle can relax somewhat, and the symptoms of spasticity can be reduced. When taken in pill form baclofen can be effective, but can lead to side effects such as:

These side effects can limit the amount of medication that can be used to decrease the symptoms of spasticity. However, the medication can also be injected around the spinal cord, directly into the cerebral spinal fluid. When used in this way, only small amounts of the medication are needed, and side effects may be reduced.

Quick GuideMultiple Sclerosis (MS) Symptoms and Treatment

Multiple Sclerosis (MS) Symptoms and Treatment
Picture of nerve pathways

Multiple Sclerosis (MS) Treatment Options

Treatment of MS depends on the stage and symptoms of the disease. Examples of drugs used to treat multiple sclerosis include:

  • Interferons
  • glatiramer acetate (Copaxone)
  • natalizumab (Tysabri)
  • alemtuzumab (Lemtrada)
  • mitoxantrone (Novantrone)

MS symptoms also may be managed with prescription drugs.

How is an intrathecal baclofen pump used to treat multiple sclerosis (MS)?

Baclofen can't treat MS itself. However, this medication can be effective in reducing the symptoms associated with severe spasticity caused by MS.

Who is a good candidate for an intrathecal baclofen pump?

There are various selection criteria used to determine if someone with MS is a candidate for an intrathecal baclofen pump. The primary consideration is the presence of spasticity that interferes with the individual's daily activities or care. If someone with MS has primary weakness, then the intrathecal baclofen pump is not an option. Other considerations include limited response to oral baclofen or intolerable side effects at the doses that are required to control the spasticity as well as a good response to a screening test of intrathecal baclofen administered into the cerebrospinal fluid. Prior to implantation of the pump, there must not be any sign of infection.

How does an intrathecal baclofen pump work?

The pump is implanted under the skin and is connected to a catheter (tube) that ends in the spinal fluid. The specific area of placement of the tubing is dependent on each patient and their associated symptoms. The pump has a small reservoir where the medication (baclofen) is placed and is programmed to deliver a specific amount of medication on a regular basis to the cerebrospinal fluid. The exact amount of medication delivered is unique to each patient and can be adjusted based upon symptoms. The programming is initially performed each month after the pump is implanted; once a patient has reached a stable dose, then the pump is checked and refilled every two to three months.

How can I expect to feel after having an intrathecal baclofen pump implanted?

Implanting a pump is a surgical procedure, and many patients experience some soreness around the surgical site after the pump is implanted. The pump is typically located in the abdomen, and some patients find that clothing that rubs over the area is uncomfortable. Some surgeons may fill the pump during the implantation, so that it starts working right away, while others wait a short time after the surgery is completed prior to filling the reservoir with medication. Once medication is flowing, benefits may be identified in six to eight hours.

What are the potential risks and side effects of an intrathecal baclofen pump?

As with any surgery, there is a risk of infection around the area of the pump or tubing. If this is seen, the pump and tubing may need to be removed to allow the infection to clear.

  • The pump must be assessed and refilled regularly; abruptly stopping the baclofen can be dangerous.
  • Patients who have an intrathecal baclofen pump shouldn't drink alcohol, as this can increase the risk of side effects such as sleepiness.
  • Exposure to heat, such as from a hot tub or heating pad, can increase the flow of medication, which could lead to an overdose.
  • Certain types of MRI should be avoided, as this could cause problems with the pump.

How much does a pump cost? Does insurance cover a intrathecal baclofen pump?

Intrathecal baclofen pump therapy is approved by the FDA; as such, most insurance companies pay for this procedure and follow-up care. However, every plan is different, and the amount of coverage may vary.

Medically reviewed by Joseph Carcione, DO; American Board of Psychiatry & Neurology

REFERENCES:

Rizzo MA, Hadjimichael OC, Preiningerova J, Vollmer TL. Prevalence and treatment of spasticity reported by multiple sclerosis patients. Mult Scler. 2004 Oct;10(5):589-95.

Vender JR, Hughes M, Hughes BD, Hester S, Holsenback S, Rosson B. Intrathecal baclofen therapy and multiple sclerosis: outcomes and patient satisfaction. Neurosurg Focus. 2006 Aug 15;21(2):e6.

Last Editorial Review: 9/13/2016

Reviewed on 9/13/2016
References
Medically reviewed by Joseph Carcione, DO; American Board of Psychiatry & Neurology

REFERENCES:

Rizzo MA, Hadjimichael OC, Preiningerova J, Vollmer TL. Prevalence and treatment of spasticity reported by multiple sclerosis patients. Mult Scler. 2004 Oct;10(5):589-95.

Vender JR, Hughes M, Hughes BD, Hester S, Holsenback S, Rosson B. Intrathecal baclofen therapy and multiple sclerosis: outcomes and patient satisfaction. Neurosurg Focus. 2006 Aug 15;21(2):e6.

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