Complicati ons of Tre atment of Severe Spasticity with Implantable Pump Systems

Czech version

Authors: I. Štětkářová ¹; I. Vrba ²; J. Peregrin ¹; J. Šro ubek ³
Authors‘ workplace: Ne urologické oddělení Nemocnice Na Homolce, Praha ¹; ARO Nemocnice Na Homolce, Praha ²; Ne urochirurgické oddělení Nemocnice Na Homolce, Praha ³
Published in: Cesk Slov Neurol N 2008; 71/104(4): 458-465
Category: Short Communication

Práce byla podpořena grantem IGA MZ ČR NR- 8523-3 a částečně výzkumným záměrem MSM0021620849.

Overview

Objective:
Severe spasticity as a result of a central nervo us system affecti on is difficult to influence by standard therapi es in a number of cases. In recent ye ars, continuo us administrati on of baclofen in the intrathecal space using pump systems has proven effective. The main indicati on criteri on for the implantati on of a pump is a positive response to a single intrathecal administrati on of baclofen. After the implantati on of the pump system, the effici ent dose is titrated and after that the pump’s reservo ir is refilled on a regular basis. Possible pump system complicati ons are classifi ed into pharmacological complicati ons, problems associ ated with the implantati on of the system, and complicati ons related to the activity of the system as such. The study provides a list of complicati ons and the respective soluti ons appli ed in o ur set of pati ents.

Materi al and methods:
The effect of intrathecally administered baclofen was tested in 19 pati ents with severe spasticity and in one pati ent with generalised dystoni a. Based on the effect of tested baclofen, we subsequently implanted pump systems to nine persons with multiple sclerosis and five persons with a chronic spinal injury. An X‑ray or a CT was performed in all cases to specify the positi on of the catheter; in one pati ent, also CT myelography was performed. In order to check the thro ughput of the catheter, a contrast substance was appli ed by the lateral port of the pump in two pati ents.

Results:
Transitory cephale a and hypotensi on were recorded in two persons after single intrathecal administrati on of baclofen. During implantati on and in the peri od which followed, complicati ons were recorded in six persons. They were: overdosing with baclofen (one person), local infecti on (one person), liquor le akage (one person) and catheter complicati ons (three persons).

Conclusi on:
Even tho ugh continuo us applicati on of baclofen using pump systems is a safe method of tre atment of severe spasticity, it is necessary to be ar in mind possible complicati ons and adverse drug effects; these, however, tend to be of minor severity and can be successfully resolved, ide ally in speci alised centres.

Key words:
spasticity – intrathecal applicati on of baclofen – pump systems – complicati ons of tre atment with intrathecal baclophen

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