Pediatric Movement Disorders - Treatments

Baclofen Pump

Baclofen acts by stimulating GABA type B receptors in the spinal cord and oral baclofen is often helpful in the treatment of spasticity. In order to avoid the side effects of high oral doses of baclofen, the medicine may be continuously administered into the space surrounding the spinal cord via a pump. The pump is implanted in the abdomen and connected to a small tube. This tube is tunneled under the skin around the back and then inserted into the space around the spinal cord (the intrathecal space). Very small doses are given. The pump is refilled approximately every three months by injection directly through the skin into the pump's reservoir. This technique is extremely effective for some children with spasticity or dystonia that affects the arms and legs. If it is not effective, the pump and tubing may be removed without significant permanent effects. This therapy is associated with complications including pump infections, catheter problems, and spinal fluid leakage around the catheter into the subcutaneous tissues. Baclofen withdrawal is another potential complication. In spite of the complications, the majority of patients and families who are treated with ITB feel that the benefits of treatment outweigh the risks. Recent reports suggest that the baclofen pump may also be helpful in generalized dystonia, although the mechanism of this effect is not known.