Mary's story TDD therapy for severe spasticity

This story recounts the experience of one individual who has a TDD pump. Medtronic invited him to share his story candidly. Please bear in mind that the experience is specific to this particular person. Not everyone who receives the treatment will receive the same results as the patient in this story. Talk with your doctor to determine if TDD Therapy with drug injection is right for you.

Mary sitting outside with a book on her lap.

Life after a stroke

On an evening in 2001, Mary was in the hospital and was scheduled to have a hysterectomy the following morning. While in her hospital bed, Mary experienced what she thought was a sinus headache.

The "headache" was actually a stroke. Fibroids in Mary's uterus were generating blood clots; one reached her brain, causing a stroke. By morning, Mary had lost the use of her left arm and leg, and had paralysis on the left side of her face.

For the next 2 months, Mary remained in the hospital, separated from her 12-year-old son and the church community where she worked as a pastor. After 6 months of intense physical therapy, Mary's left foot was still turning inward on its side. Each step was treacherous, with severe spasticity keeping her leg muscles so tight she couldn't bend at her knee or hip.


"After all those months of therapy, my physical therapist told me the motion I'd achieved was probably as good as it was going to get," recalls Mary. "She told me to be happy with it and move on. But I couldn't leave it at that. I expected more from life, and more from myself."

Determined to reach a higher level of mobility and comfort, Mary explored other resources. She began working with a new therapist who referred her to a physician in Houston, Texas. The physician told Mary she could address the spasticity in her leg, joints, and arm, and possibly help her become more active with TDD Therapy.

During a screening test, a dose of liquid medication relieved the spasticity on Mary's left side, indicating she could be a candidate for the therapy. The pump was surgically placed in May 2003.

Mary didn't experience any complications with her surgery. However, some people do experience surgical complications, side effects of the drug, or both. There are risks associated with treatment with a TDD pump. Some of these risks include meningitis, spinal fluid leak, infection, paralysis, headache, swelling, bleeding, and bruising. Drug-related side effects may include loose muscles, drowsiness, nausea/vomiting, headache, and dizziness.

Life with a targeted delivery pump

With her pump, Mary enjoys an active life. She's a part-time pastor at her church, and participates in water aerobics and Pilates classes. After her son graduated and went off to college, Mary moved into a townhouse with her son's golden retriever, Mover. "That means I go out dog walking a couple of times a day around the townhouse complex. For the cooler months, we have found dog parks where Mover can run, play, and swim in the dog pool. I use the people paths to walk a mile or so each time. The Targeted delivery pump has given me independence to keep doing the things I enjoy," says Mary.

"My foot has returned to a more natural angle. It still drags, but twisting it when I walk is no longer a concern. I feel such relief in my legs, trunk, and back."

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 TDD therapy with drug injection

When receiving TDD Therapy with drug injection make sure you follow your clinician’s instructions closely. A sudden stop in therapy can result in serious medication 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. You should also know the early symptoms of prescribed medication withdrawal. Some people are at more risk than others for medicine withdrawal; speak with your clinician about this.


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 TDD Therapy?

A: Targeted drug delivery is a treatment using prescribed medication 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 prescribed medication 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 TDD Therapy?

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 TDD Therapy. If your spasticity is due to spinal cord injury or multiple sclerosis and is not controlled with medication taken by mouth or you have side effects that are not acceptable from oral medication 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 TDD Therapy. Safety and efficacy in patients under the age of 4 has not been established.

Q: What are the most common side effects of intrathecal medication?

A: The side effects of intrathecal medication 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 intrathecal medication 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 intrathecal medication?

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.