intrathecal baclofen pump
/ in-truh-THEE-kul; ITB /
Baclofen calms spasticity by acting in the spinal cord, but taken as a pill it must first flood the whole body and brain to get a little of it down to the cord — which is why oral baclofen so often makes a person drowsy and foggy before it relaxes the legs. The intrathecal baclofen pump solves this by delivering the drug exactly where it is needed: a thin tube drips it directly into the fluid bathing the spinal cord, so a tiny fraction of the oral dose does the job with far less reaching the brain.
The system is an implanted device. A hockey-puck-sized pump, holding a reservoir of baclofen, is placed under the skin of the abdomen; a fine catheter runs from it around to the spine and into the intrathecal space (the fluid-filled sheath around the cord). The pump is programmed to release a steady, adjustable micro-dose, and the reservoir is refilled with a needle through the skin every few months. Before committing, candidates usually get a test dose to confirm it helps. Because the dose at the cord is high but the dose to the brain is low, it can powerfully reduce severe, widespread lower-body spasticity while keeping the person far more alert than oral medication would.
In rehabilitation the pump is reserved for severe, generalized spasticity — typically of the legs and trunk — that oral drugs cannot control without intolerable sedation, often after spinal-cord injury, cerebral palsy, or multiple sclerosis. The honest cautions are serious: it is surgery with the usual risks plus device problems (catheter kinks, pump failure, infection), and the most dangerous issue is sudden withdrawal — if the delivery stops unexpectedly, baclofen levels crash and can cause a life-threatening rebound of spasticity, fever, and instability. It needs a committed program for refills and monitoring.
A woman with a spinal-cord injury has such severe leg and trunk spasticity that the oral dose needed to control it leaves her too sleepy to do anything. A test dose into her spinal fluid relaxes her dramatically while she stays alert, so her team implants a pump — and books her into a reliable schedule of refills, knowing a missed one could be dangerous.
Drug delivered straight to the cord: big effect on tone, small dose to the brain, less sedation.
The pump's gravest hazard is abrupt withdrawal: a catheter failure or missed refill can cause a sudden, life-threatening rebound of spasticity, high fever, and instability. It demands a committed refill and monitoring program, not a one-time procedure.