What Is ITB Therapy? ITB Therapy for Severe Spasticity

WHY CONSIDER A BACLOFEN PUMP?

If treatments like pills or injections aren't giving you enough relief from severe spasticity, talk to a specialist about the FDA-approved treatment option called ITB TherapySM with Lioresal® Intrathecal (baclofen injection).


WHAT IS SEVERE SPASTICITY?

Severe spasticity is a condition in which tight, stiff muscles make it difficult to control your arms, legs, or body. Spasticity can cause spasms, pain, and disability. Spasticity is considered severe when it gets in the way of daily activities, sleep patterns, and caregiving.

Spasticity occurs when nerves in the brain or spinal cord that control movements are injured. Spasticity is often related to cerebral palsy, brain injury, stroke, multiple sclerosis, and spinal cord injury.


WHY IS TREATMENT IMPORTANT?

The right treatment may make work, school, activities, and caregiving easier. It may give you greater comfort and control, allowing you to rethink what's possible.


WHEN OTHER TREATMENTS AREN'T WORKING

Many people can control spasticity well enough with oral medication, physical and occupational therapy, or injection therapy, but some find that these treatments don't work well enough or have intolerable side effects. Consider a baclofen pump if:

  • You aren't getting enough relief from other spasticity treatments.
  • You're struggling with drug side effects like drowsiness, confusion, weakness, and nausea.
  • You suffered a traumatic brain injury at least one year ago.

Safety and efficacy in patients under the age of 4 has not been established.


WHY A PUMP IS DIFFERENT

A common medication for spasticity is a muscle relaxer called baclofen. Taken orally, baclofen works well for many people, but in some may cause debilitating side effects like weakness, drowsiness, or nausea.

When baclofen is taken orally as a pill, most of the drug stays in the bloodstream. Only a small amount reaches the fluid surrounding the spinal cord, even at very high doses. In contrast, the pump delivers baclofen directly into the spinal fluid. When medicine is delivered right where it is needed, you need less, which may help minimize some of the possible side effects that may accompany oral baclofen.1


HOW THE PUMP WORKS

A baclofen pump delivers a precise amount of Lioresal® Intrathecal (a liquid form of baclofen) directly into the fluid that surrounds the spinal cord. This area is called the intrathecal space. A surgeon places the pump just under the skin of the abdomen. The pump is programmed wirelessly to release the right amount of medicine at the right time for the individual. Most patients say the pump feels comfortable and does not interfere with their day-to-day movements.

Treatment with a baclofen pump is also called ITB Therapy with Lioresal® Intrathecal (baclofen injection). The drug used in the pump for treatment of severe spasticity is called Lioresal Intrathecal.

The pump and medication are covered by most private health insurance plans, Medicare, and most state Medicaid programs. The treatment is approved by the FDA.


Information on this site should not be used as a substitute for talking with your doctor. Always talk with your doctor about diagnosis and treatment information.


PATIENT IMPORTANT SAFETY INFORMATION FOR ITB THERAPYSM WITH LIORESAL® INTRATHECAL (baclofen injection)

When receiving ITB TherapySM with Lioresal® Intrathecal (baclofen injection), make sure you follow your clinician’s instructions closely. A sudden stop in therapy can result in serious baclofen withdrawal symptoms, such as high fever, changed mental status, muscle stiffness, and in rare cases, may result in the loss of function of many vital organs and death.

It is critical that your clinician be called right away if you experience any of these symptoms. Make sure you keep your scheduled refill visits so you don’t run out of medication (baclofen). You should also know the early symptoms of baclofen withdrawal. Some people are at more risk than others for baclofen withdrawal; speak with your clinician about this.

 

Q: What is Lioresal® Intrathecal (baclofen injection)?

A: Lioresal® Intrathecal (baclofen injection) is a muscle relaxant and antispastic medication that is used for treatment of severe spasticity caused by injury to or certain conditions of the brain or spinal cord.

Q: What is severe spasticity?

A: Severe spasticity is a condition that results from an injury to or disease of the brain or spinal cord. Spasticity may make your muscles feel tight, stiff and difficult to move. With severe spasticity, you can experience stiffening of the muscles that makes your muscles feel like they are locked, or even jerk uncontrollably when you try to use them.

Q: What is ITB TherapySM?

A: Intrathecal Baclofen Therapy (ITB) is a treatment using Lioresal® Intrathecal (baclofen) that is delivered into the fluid around your spinal cord (intrathecal) to help manage severe spasticity. For long term treatment, the drug is placed into a pump that is surgically placed under the skin of your abdomen. The pump delivers Lioresal® Intrathecal through a small tube (catheter) into your spinal fluid. Your doctor can program the pump to deliver the appropriate daily dose for you. Before you can be considered for long term treatment, you must have a test dose to see how you respond to the drug when it is delivered in this way. After the test dose is done, your doctor will discuss the results with you and determine if you are an appropriate candidate for the therapy.

Q: Who is a candidate for ITB TherapySM?

A: People who have severe spasticity resulting from conditions of the brain or spinal cord (such as multiple sclerosis, cerebral palsy, stroke, brain injury or spinal cord injury) may be candidates for ITB TherapySM. If your spasticity is due to spinal cord injury or multiple sclerosis and is not controlled with baclofen taken by mouth or you have side effects that are not acceptable from oral baclofen taken to treat your spasticity, you may be a candidate. If you have had a brain injury due to trauma, you should wait for one year after your injury to be considered for ITB TherapySM. Safety and efficacy in patients under the age of 4 has not been established.

Q: Who is not a candidate for ITB TherapySM or a screening test dose?

A: If you are hypersensitive to baclofen, you should not use Lioresal® Intrathecal. If you have an active infection, you should not have a screening test or implant until the infection has resolved. You should not receive ITB TherapySM if you have a body size that is too small to hold the implantable pump.

Q: What are the most common side effects of Lioresal® Intrathecal?

A: The side effects of Lioresal® Intrathecal can include drowsiness, lightheadedness, dizziness, nausea and vomiting, low blood pressure, headache, seizures, and loose muscles. As with most medications, you can experience overdose (drug dose is too high) or withdrawal (drug dose is too low). Your doctor will discuss the possible effects of Lioresal® Intrathecal and what to do if you experience any of the symptoms or side effects. Sexual dysfunction in men and women including decreased libido and orgasm dysfunction have been reported.

Q: What do I need to know if I am using Lioresal® Intrathecal?

A: All patients and caregivers should receive information on the risks of the treatment. Your doctor should give you information of the signs and symptoms of receiving too much or too little medication (overdose or withdrawal) and what to do if you notice those symptoms.

Q: What are the signs of withdrawal from Lioresal® Intrathecal?

A: An increase in your spasticity, itching, low blood pressure, lightheadedness, and a tingling sensation are the most common signs with withdrawal from Lioresal® Intrathecal. In rare cases, severe withdrawal symptoms may occur including high fever, change in mental status, extreme spasticity that is worse than before starting Lioresal® Intrathecal and muscle rigidity. If you experience any of these signs, it is extremely important that you or your caregiver contact your doctor immediately. If the sudden withdrawal is not treated, in rare cases, more severe medical conditions can develop that can result in death.

Q: What can I do to prevent Lioresal® Intrathecal withdrawal or abrupt interruption of Lioresal® Intrathecal?

A: It is very important that you not miss refill appointments. If you plan to travel let your doctor know so that your refill can be scheduled so that you don’t run out of medication. If you are hospitalized for any reason near the time of your refill, you or your caregiver should let your doctor know before the refill date so that arrangements can be made to refill your pump. Not all hospitals have doctors that can refill pumps, so let your doctor know as soon as possible if it is near your refill date. You should be aware of what your pump alarms sound like. If you hear an alarm, contact your doctor immediately.

Q: What are the signs of Lioresal® Intrathecal overdose?

A: Signs of receiving too much medication (overdose) can appear suddenly or gradually over a few days. Signs may include muscles being too loose, drowsiness, lightheadedness, dizziness, sleepiness, slowed or shallow breathing, lower than normal body temperature, seizures, loss of consciousness, and coma. It is very important that you or your caregiver contact your doctor immediately if you experience any of these signs and that you be taken to a hospital for treatment.

Q: What are the potential pump and catheter implant procedure complications?

A: The implanted pump and catheter are placed under the skin of the abdomen during a surgery. Some complications that you may experience with the implant surgery include infection, meningitis (infection of the lining of the brain and central nervous system), spinal fluid leak, paralysis, headache, swelling, bleeding, and bruising.

Q: What are the potential pump and catheter complications that can occur after implant?

A: Once the infusion system (the pump and the catheter) is implanted, device complications may occur that may require surgery to remove or replace the pump, catheter or catheter fragment. Some of these device complications may impact the flow of medication delivered, which may cause symptoms of overdose or withdrawal of Lioresal® Intrathecal.

Possible complications include an internal component failure which may result in a loss of therapy, or an inability to program the pump. The pump, catheter or catheter fragment could migrate within the body or erode through the skin. Tissue or an inflammatory mass may form at the tip of the catheter in the intrathecal space and may cause a loss of therapy or neurological impairment including paralysis. The catheter could leak, tear or become disconnected resulting in delivery of medication into the area under the skin where the pump is implanted and/or along the catheter path. The catheter could kink or become blocked resulting in no delivery of medication. The pump could stop because the battery has run out or because of a problem with one or more of its inner parts. Errors in locating the pump during the refill procedure can result in symptoms of overdose that may be serious or life-threatening.

Q: Can I undergo Magnetic Resonance Imaging (MRI) testing?

A: Under certain conditions, an MRI can be conducted with the pump. Always inform your doctor that you have an implanted infusion system before any medical or diagnostic procedure such as MRI or diathermy. Please ask your doctor to determine if the MRI scan can be used with the pump. The MRI will cause your pump to temporarily stop, which will suspend drug delivery during the MRI. The pump should resume normal operation and drug delivery after the MRI is complete. Your pump may also temporarily sound an alarm during the scan; the alarm should stop at the conclusion of the scan. Following your MRI, your doctor should check your pump to confirm that it is working properly.

You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit http://www.fda.gov/medwatch, or call 1-800-FDA-1088.

The risk information provided here is not comprehensive. To learn more, talk about ITB TherapySM and Lioresal® Intrathecal with your doctor and refer to the FDA-approved product labeling.

 

Lioresal® is a registered trademark of Saol.
Rx Only
Rev 0418
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1

Penn RD, Savoy SM, Corcos D, et al. Intrathecal baclofen for severe spinal spasticity. N Engl J Med 1989; 320: 1517-1521