Oral medication, the usual method for dealing with mild to moderate spasticity, may not work well in severe cases. Let’s look at implanted devices as an effective approach to managing severe spasticity
Spasticity is a common complication seen after SCI, traumatic brain injury and stroke. In ROLLING INSPIRATION issue 3 of 2017, I highlighted spasticity management and mentioned the common triggers that increase spasticity. But in a small percentage of patients, spasticity can be so severe that the usual management methods are not effective.
Commonly, medications are used to manage mild to moderate spasticity. Baclofen is the oral medication of choice. Yet, as with any medication, side effects are common and this is especially true at higher doses. Overwhelming or poorly controlled spasticity can be the cause for many complications. Long term complications and clinical problems associated with spasticity include:
Contractures: This is the shortening of the tendon resulting in the inability to put a joint through its normal range of motion. Severe contractures can complicate the care of patients by making dressing, placement in a wheelchair, hygiene and general care difficult.
Seating: Very spastic patients are difficult to seat, and specialised supports such as trunk supports may be necessary.
Gait: Severe spasticity can impact on the ability to walk. Spasm may make gait pattern unsafe and predispose patients to injury or confine potentially mobile patients to wheelchairs.
Upper limb dexterity: Spastic upper limbs limit functional use of that limb, making tasks such as grooming, eating, computer use and driving difficult or impossible.
Pain: Severe spasm can precipitate pain.
Pressure sores: Through ongoing friction, spasticity can cause pressure sores.
In severe cases of spasticity a very effective way of managing it is with the use of an implanted medication delivery device.
The baclofen pump system consists of a pump and a catheter that brings the medication from the pump into the spinal fluid. The pump and catheter are implanted under the skin. Normally the pump is implanted on the front of the abdomen as shown in the diagram.
The pump has a reservoir that carries the liquid baclofen. It is periodically filled as an out-patient procedure. Very small doses of baclofen are then delivered to the spinal fluid on a continuous basis.
The delivery of baclofen to the spinal fluid is a very effective way of managing severe spasticity without side effects.
If you suffer from severe resistant spasticity or the side effects of oral medication are intolerable, you may be a candidate for an implanted baclofen pump. Medication pumps have been used for decades and have vastly improved the quality of life of many patients.
The implant procedure is done in theatre and often patients are discharged the following day. Speak to your rehabilitation doctor if you’d like to find out more about this treatment option.
Dr Ed Baalbergen is the medical officer at the Vincent Pallotti Rehabilitation Centre (Cape Town) and is a member of the International Spinal Cord Society and the Southern African Neurological Rehabilitation Association. email: firstname.lastname@example.org