The intrathecal baclofen program is directed by Dr. Esias Van Rensburg, developmental pediatrician at the Children’s Rehabilitation Center at the Sunnyhill Hospital campus of Children’s and Women’s Health Center.
Intrathecal baclofen involves the implantation of a large pump into the abdomen, to allow continuous delivery of the drug, baclofen, with which the reservoir of the pump is filled. The pump is attached to a small catheter, the end of which is placed into the spinal fluid space in the back. The pump delivers the baclofen slowly, and after 2-3 months, when all the drug is gone, the pump can be refilled by injecting more baclofen into the pump reservoir using a small needle inserted into the pump through the skin. The pump is expensive and children are tested before implantation of the pump to determine if they respond to the baclofen. This is done by doing a spinal tap and injecting a test dose of baclofen. Alternatively, a small catheter may be inserted into the spinal fluid space in the back, with one end of the catheter coming to the outside through the skin. Baclofen can then be instilled into the spinal fluid space through this catheter over the next few days either as individual injections or continuously using an external pump.
Our center was one of the first to report on the use of intrathecal baclofen for treatment of spasticity secondary to disorders of the brain (spasticity of cerebral origin) in children. Our early results were positive, but there were many complications and the costs associated with this treatment were high. As a result this modality of treatment was used infrequently, and in highly selected children.