What is multiple sclerosis (MS)?
Multiple sclerosis (MS) is a disease that causes demyelination of the brain
and spinal cord, or a loss of the protective covering around nerve fibers called
axons. When this occurs, the axons (the parts of the nerve cells that transmit
impulses to other cells) don’t work well. As more areas are affected by the loss
of myelin, different symptoms develop. The specific symptoms seen in MS are related to
the area of injury in the brain or spinal cord. Patients might experience or
describe numbness, tingling, or weakness. The weakness might be mild or severe
enough to cause paralysis of one side of the body. In some cases, patients may
develop loss of control of their bladder or an inability to empty their bladder.
As MS progresses, some patients are left with muscle spasticity, which is an
involuntary painful contraction of some muscles.
What is spasticity?
Spasticity
is a condition in which muscles are exhibiting almost constant contracture or
activity, leading to loss of range of motion, decreased function, and even pain.
Spasticity occurs after an area of the brain or spinal cord has been injured,
leading to weakness and increased tone. When an arm or leg that is affected by
spasticity is moved by a health-care professional, there is involuntary resistance to that
movement. Often, this spasticity is made worse when the speed (or velocity) of
the movement increases. Spasticity is often seen in association with a brain
injury, such as after:
- a
stroke, - traumatic damage to the brain or spinal cord, or
- in cases of MS.
What is baclofen, and what are its side effects?
Baclofen
is a medication that works in the brain to decrease uninhibited signals that
start in an injured area of the brain and cause spasticity. By decreasing these
signals, the affected muscle can relax somewhat, and the symptoms of spasticity
can be reduced.
When taken in pill form baclofen can be effective, but can lead to side effects
such as:
These side
effects can limit the amount of medication that can be used to decrease the
symptoms of spasticity. However, the medication can also be injected around the
spinal cord, directly into the cerebral spinal fluid. When used in this way,
only small amounts of the medication are needed, and side effects may be
reduced.
Multiple Sclerosis (MS) Treatment Options
Treatment of MS depends on the stage and symptoms of the disease. Examples of drugs used to treat multiple sclerosis include:
- Interferons
- glatiramer acetate (Copaxone)
- natalizumab (Tysabri)
- alemtuzumab (Lemtrada)
- mitoxantrone (Novantrone)
MS symptoms also may be managed with prescription drugs.
Read more about multiple sclerosis (MS) treatment options »
How is an intrathecal baclofen pump used to treat multiple sclerosis (MS)?
Baclofen
can’t treat MS itself. However, this medication can be effective
in reducing the symptoms associated with severe spasticity caused by MS.
Who is a good candidate for an intrathecal baclofen pump?
There are
various selection criteria used to determine if someone with MS is a candidate for an intrathecal baclofen pump.
The primary consideration is the presence of spasticity
that interferes with the individual's daily activities or care. If someone
with MS has primary weakness,
then the intrathecal baclofen pump is not an option. Other considerations
include limited response to oral baclofen or intolerable side effects at the
doses that are required to control the spasticity as well as a good response to
a screening test of intrathecal baclofen administered into the cerebrospinal
fluid. Prior to implantation of the pump, there must not be any sign of
infection.
How does an intrathecal baclofen pump work?
The pump
is implanted under the skin and is connected to a catheter (tube) that ends in
the spinal fluid. The specific area of placement of the tubing is dependent on
each patient and their associated symptoms. The pump has a small reservoir where
the medication (baclofen) is placed and is programmed to deliver a specific
amount of medication on a regular basis to the cerebrospinal fluid. The exact
amount of medication delivered is unique to each patient and can be adjusted
based upon symptoms. The programming is initially performed each month after the
pump is implanted; once a patient has reached a stable dose, then the pump is
checked and refilled every two to three months.
How can I expect to feel after having an intrathecal baclofen pump implanted?
Implanting
a pump is a surgical procedure, and many patients experience some soreness
around the surgical site after the pump is implanted. The pump is typically
located in the abdomen, and some patients find that clothing that rubs over the
area is uncomfortable. Some surgeons may fill the pump during the implantation,
so that it starts working right away, while others wait a short time after the
surgery is completed prior to filling the reservoir with medication. Once
medication is flowing, benefits may be identified in six to eight hours.
QUESTION
What kind of disease is multiple sclerosis?
See Answer
What are the potential risks and side effects of an intrathecal baclofen
pump?
As with
any surgery, there is a risk of infection around the area of the pump or tubing.
If this is seen, the pump and tubing may need to be removed to allow the
infection to clear.
- The pump must be assessed and refilled regularly;
abruptly stopping the baclofen can be dangerous. - Patients who have an intrathecal baclofen pump shouldn’t drink alcohol, as this can increase the risk
of side effects such as sleepiness. - Exposure to heat, such as from a hot tub or
heating pad, can increase the flow of medication, which could lead to an
overdose. - Certain types of
MRI should be avoided, as this could cause problems
with the pump.
How much does a pump cost? Does insurance cover an intrathecal baclofen pump?
Intrathecal baclofen pump therapy is approved by the FDA; as such, most insurance companies pay for this procedure and follow-up care. However, every plan is different, and the amount of coverage may vary.