STEP 2: Spasticity Live Course - April 25-26, 2025, in Rosemont, IL-Spinal Cord Injury Paraplegia Leading to IBT

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The document describes the application of Intrathecal Baclofen (ITB) therapy for managing spasticity in patients with spinal cord injury (SCI), specifically detailing treatment for a 52-year-old female patient with a C6 complete SCI. The text outlines various aspects of ITB, including benefits such as the diffuse treatment of spasticity and the potential to discontinue oral medications. However, it also highlights disadvantages like the need for surgical intervention and the challenges in patient selection.<br /><br />Mary Beth Russell, DO, MS, discusses the patient's history, including prior apprehensions about ITB and current anticoagulant use due to a deep vein thrombosis (DVT). The patient experiences global spasticity affecting daily activities, inadequately controlled by oral medications like baclofen and dantrolene.<br /><br />During an ITB screening test, the patient showed significantly reduced muscle tone, improved sitting balance, and enhanced comfort with transfers, without experiencing leg spasms triggered by normal meal consumption, indicating a positive response to the therapy. Following successful screening, an ITB pump was implanted, leading to titration of the effective dose in an inpatient setting, with full discontinuation of oral spasticity medications. The patient reported improved quality of life due to decreased spasms and lower anxiety.<br /><br />ITB therapy uses a combination of basal rates and flexible dosing regimens to target problematic periods of heightened spasticity. While it provides broad benefits in managing spasticity, the therapy comes with limitations such as the need for repeated surgical interventions for device replacement, the risk of withdrawal symptoms, and the geographical or social limitations for refilling the device.<br /><br />Overall, ITB offers significant advantages in managing spasticity, although it requires careful consideration of surgical, geographical, and patient-specific factors.

Asset Subtitle

Mary Beth E. Russell, DO, MS

Keywords

Intrathecal Baclofen

spasticity management

spinal cord injury

C6 complete SCI

surgical intervention

anticoagulant use

ITB screening test

oral medication discontinuation

quality of life improvement

device replacement