Managing Spasticity in Children
with Intrathecal Baclofen

Disclaimer: This information sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

What is intrathecal baclofen and how does it work?

Baclofen is a medication that can help to reduce spasticity. It can be given orally (by mouth - see oral baclofen) or intrathecally (into the spinal canal). When given intrathecally, the dose required is only one hundredth that of the oral dose. This is because baclofen acts on receptors in the spinal cord, which it can not get to easily when given orally. Giving the medication intrathecally (from where it is easily absorbed by the spinal cord) means that side effects seen with the oral medication such as drowsiness are less often seen with this method of administration.

To be able to give the medication intrathecally, an implanted pump with a catheter (tubing) going into the spine is required. For this, the child is admitted for surgery and a small pump is inserted into the abdomen with a catheter going from the pump into the fluid around the spine to deliver the medication. The pump is refilled with medication every 2 to 3 months. This is done in the outpatients department, and at the same time the pump can be programmed to give varying amounts of baclofen. This allows for a graded reduction in the level of spasticity for the child. The pump does not interfere with any activities such as hydrotherapy or other therapy.

Children who might benefit from this treatment fall into two groups:

1. Those in whom the aim is to make it easier to do cares such as dressing, washing and feeding,
   
   
2. A second group in whom the aim is to improve functions such as walking or use of upper limbs. For both groups of children and their carers, improved quality of life is a major goal of this treatment.

Possible side effects from this treatment include infection of the pump or catheter (in about 5% of cases), pump malfunction (about 1% of cases), and excessive weakness (although this usually improves if the dose is decreased). Your specialist will discuss these effects further with you if you are considering this treatment for your child.

There is more information available from your specialist including booklets specifically on intrathecal baclofen as well as several videos. A website giving more information about the pump is at www.medtronic.com/neuro/spasticity. Should you wish to have more information on intrathecal baclofen, or any other spasticity management, please contact one of the following persons:

• Dr Adam Scheinberg (02) 9845 2132
• Dr Stephen O'Flaherty (02) 9845 2819
• Dr Mary-Clare Waugh (02) 9845 2131
• Kathryn Clark (02) 9845 2767
• Natasha Lannin (02) 9845 2769

For more information about treatment of Spasticity please refer to links below:

• Botulinum Toxin Injections
• Oral Baclofen
• Spasticity

Rehabilitation Department The Children's Hospital at Westmead Cnr Hawkesbury Rd & Hainsworth St, Westmead Locked Bag 4001, Westmead, 2145 Tel: (02) 9845 2132 - Fax: (02) 9845 0685 http://www.chw.edu.au/rehabilitation/