STEP 2: Spasticity Live Course - April 25-26, 2025, in Rosemont, IL-Multiple Sclerosis Quadriparesis Leading to Intrathecal Baclofen Disruption

Pdf Summary

The document discusses troubleshooting intrathecal delivery systems using a case-based learning approach, presented by Dr. Michael Saulino. Intrathecal delivery systems are used to administer drugs like baclofen directly to the spinal cord to manage conditions such as spasticity. The document presents a complex case of a 45-year-old man with spastic paraparesis and a 15-year history of primary-progressive multiple sclerosis (PP-MS), experiencing problematic hypertonia and mobility issues.<br /><br />The patient’s history includes a transition from oral muscle relaxants and botulinum toxin injections to intrathecal baclofen therapy due to excessive sedation from oral medication. After implanting the intrathecal system, the patient initially experiences a reduction in muscle tone but eventually faces episodic elevations in tone, which seem correlated with urinary tract infections and changes in therapy.<br /><br />The troubleshooting process involves considering differential diagnoses including disease progression, noxious stimuli, and mechanical issues with the pump or catheter. The document outlines steps for verifying the integrity of the delivery system via electronic logs, radiographic imaging, and advanced techniques like catheter dye studies and nuclear medicine cisternograms, albeit with certain technical and logistical challenges.<br /><br />In this particular case, the solution involved reducing the intrathecal baclofen dose, supplementing with oral baclofen, and replacing the catheter while adjusting dosing strategies to manage spasticity effectively. The document emphasizes a comprehensive, methodical approach for clinicians to diagnose and address intrathecal delivery system complications, reinforcing the need for technical expertise and careful management to optimize patient outcomes.

Asset Subtitle

Michael F. Saulino, MD, PhD

Keywords

intrathecal delivery systems

case-based learning

spasticity management

intrathecal baclofen

multiple sclerosis

troubleshooting

catheter issues

muscle tone

nuclear medicine cisternograms

Dr. Michael Saulino