Dosing Patterns In Treatment of Disabling Spasticity With Intrathecal Baclofen

Abstract

Purpose: The aim of this study was to describe and analyze dosing patterns for patients with ITB treatment over time and to identify possible subgroups demonstrating diversity in patterns. Design: A retrospective design. Methods: For 81 patients from six different hospitals, baclofen doses from the first 2 years of treatment were identified using medical records. Line graphs of each patient's doses were analyzed and grouped based on similarities in dosing pattern. Findings: The analyses of the dosing patterns resulted in four different subgroups classified as stable, slow increase, rapid increase, and fluctuating. Conclusion:The results highlight the clinical challenge of predicting dose development over time. Clinical Relevance to Rehabilitation Nursing: This study provides rehabilitation healthcare professionals with a better understanding of intrathecal baclofen dose development. Illustrations of the four subgroups can be used as an educational tool for patients, family, and caregivers.

Patients’ Expectations Before Initiation of Intrathecal Baclofen Treatment: A Longitudinal Study with 1-Year Follow-Up

“…A limitation is that follow-up took place after 1 year and some patients may need a longer time to achieve steady state, which could affect the experienced satisfaction with treatment ( 39 , 40 ). Furthermore, baclofen dose development was not followed.…”

Spasticity Management after Spinal Cord Injury: The Here and Now

“…ITB is administered continuously via an internal pump, reservoir, and catheter system that is programmed to deliver baclofen into the thecal space, essentially bathing the spinal cord with medication. By delivering concentrated medication directly to the spinal cord, the provider is able to drastically reduce the dosage (ITB dosed in micrograms), thereby limiting side effects [ 34 , 35 , 36 , 37 ]. The system can be assessed intermittently to optimize dosing administration, and refills can be extended to several months, depending on the concentration of baclofen placed in the reservoir.…”

“…The system can be assessed intermittently to optimize dosing administration, and refills can be extended to several months, depending on the concentration of baclofen placed in the reservoir. Minor surgery is required to place the pump, and although infrequent, mechanical failures can happen, leading to overdose or withdrawal symptoms [ 34 , 35 , 36 , 37 ]. An essential element of managing ITB pumps is troubleshooting either loss of ITB efficacy or ITB overdose, both of which can appear as life-threatening circumstances [ 36 ].…”

Concomitant Brain Injury and Spinal Cord Injury Management Strategies: A Narrative Review

“…Unfortunately, it also weakens muscles under voluntary control, which may be helpful for the person with TBI who has diffuse spasticity, but can be very limiting for the person with SCI [ 75 ]. If oral pharmacology is still insufficient or suffering side effects such as sedation, hypotension, aa programmable intrathecal baclofen (ITB) pump can be surgically implanted at the abdomen with a catheter placed in the intrathecal space for the delivery of highly concentrated baclofen into the cerebrospinal fluid [ 76 , 77 , 78 ]. The advantages of ITB are that it has a reservoir that can contain up to 3 months of baclofen, and relatively small doses are required as it is directly bathing the spinal cord with medication.…”