Questions and Answers – ITB Therapy

How does the Medtronic SynchroMed^® Programmable Drug Infusion System pump work?

The SynchroMed Drug Infusion System includes a programmable pump and catheter that are surgically placed, usually just under the skin of the abdomen. The system delivers a liquid form of the drug baclofen (Lioresal^® Intrathecal) directly to the fluid around the spinal cord, where it's needed most.

Most people report that the programmable pump is not uncomfortable or restrictive, and does not interfere with their movement. Depending on your body type, it may not show at all under regular clothes.

If oral baclofen didn’t work for me, why would a intrathecal baclofen pump work?

Because the drug is delivered directly to where it is needed in the spinal fluid, only minimal amounts circulate throughout the body in the blood. This helps minimize the possible side effects that often accompany oral baclofen.

Will ITB Therapy cure my spasticity?

While ITB Therapy (the baclofen pump) won’t eliminate the primary source of your condition or cure your disease, it may help you manage your severe spasticity symptoms. It may also allow you to participate in daily activities that have become difficult or impossible.

Am I a candidate for ITB Therapy?

Candidates for Medtronic ITB Therapy (the baclofen pump) must:

Show a positive response to Lioresal® Intrathecal (baclofen injection) in a standard screening test
Have sufficient body size to support the pump; the pump must be implanted 2.5 cm (1 in) or less from the surface of the skin
Not have any infection
Not be allergic to baclofen
Wait at least 1 year after injury (for people with traumatic brain injury only)

In addition, healthcare professionals may use the following criteria to determine if you are a candidate for ITB Therapy:

Severe spasticity or spasms that interfere with function or daily activities
Severe spasticity or spasms that interfere with care or positioning

Next: Getting ITB Therapy

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.

Safety Information – ITB Therapy

Please follow your doctor's instruction closely because a sudden stop of intrathecal baclofen therapy can result in serious illness (baclofen withdrawal symptoms) such as high fever, changed mental status, muscle rigidity, and in rare cases multiple organ-system failure and death. It is very important that your doctor be called right away if you experience any of the above symptoms.

It is important for you to keep your scheduled refill visits so you don't run out of medication (baclofen) and to understand the early symptoms of baclofen withdrawal. Some patients are at more risk than others for baclofen withdrawal; consult with your doctor.

People who suffer from severe spasticity resulting from cerebral palsy, multiple sclerosis, stroke, traumatic brain injury, or spinal cord injury may be a candidate for ITB Therapy. If you have spasticity due to spinal cord injury or multiple sclerosis you must first fail oral baclofen. If you have experienced a traumatic brain injury you must first wait 1 year after the injury to be considered for ITB Therapy. A screening test will help show if you will respond to the intrathecal baclofen. You should not receive ITB Therapy if you have an infection, are allergic to baclofen, or your body size is too small to hold the implantable pump.

The implanted pump and catheter are surgically placed beneath the skin. Surgical complications that you may experience include infection, meningitis, spinal fluid leak, paralysis, headache, swelling, bleeding, and bruising.

The most common and/or serious drug-related side effects of ITB Therapy include loose muscles, sleepiness, upset stomach, vomiting, headaches, and dizziness. Pump failure may cause overdose or underdose of intrathecal baclofen. The signs and symptoms of overdose include drowsiness, lightheadedness, respiratory depression (difficulty breathing), seizures, loss of consciousness, and coma. Once the infusion system is implanted, device complications include catheter or pump moving within the body or eroding through the skin. The catheter could leak, tear, kink, or become disconnected, resulting in underdose or no baclofen infusion. Symptoms of underdose include increase or return in spasticity, itching, low blood pressure, lightheadedness, and tingling sensation. These symptoms are often early indications of baclofen withdrawal. The pump could stop because the battery has run out or because of component failure. The pump will sound an alarm when the pump needs to be filled with baclofen, replaced or if there is a problem with the pump. Always inform any healthcare personnel that you have an implanted infusion system before any medical or diagnostic procedure such as MRI or diathermy.

For more information, please read the Lioresal^® Intrathecal (baclofen injection) Full Prescribing Information and the SynchroMed Infusion System Information.

This therapy is not for everyone. Please contact your doctor. A prescription is required.

Lioresal^® is a registered trademark of Novartis Pharmaceuticals Corporation.

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.

Last updated: 23 Apr 2009