Aaron L Boster1, Susan E Bennett2, Gerald S Bilsky3, Mark Gudesblatt4, Stephen F Koelbel5, Maura McManus6, Michael Saulino7. 1. OhioHealth Neurological Physicians, Columbus, OH, USA. 2. State University of New York (SUNY) at Buffalo, Buffalo, NY, USA. 3. The Shepherd Center, Atlanta, GA, USA. 4. Brookhaven Memorial Hospital Medical Center, South Shore Neurologic Associates, Islip, NY, USA. 5. Braintree Rehabilitation Hospital, Braintree, MA, USA. 6. Alfred I DuPont Hospital for Children, The Sidney Kimmel Medical College, Thomas Jefferson University, Wilmington, DE, USA. 7. MossRehab, Elkins Park, PA, USA.
Abstract
INTRODUCTION: Intrathecal baclofen (ITB) screening assesses response to a test dose of ITB on spasticity and function and identifies adverse reactions. METHOD: An expert panel consulted on best practices after conducting an extensive literature search and conducting an online survey. RESULTS: A successful trial may confirm predetermined goals, which may include improved mobility/positioning, decreased time/improved independence for activities, less home exercise, better wheelchair tolerance, decreased caregiver time, improved sleep, and reduced pain, or may modify goals and expectations. Individuals should not be tested in the presence of active medical issues (e.g., MS exacerbations, active urinary tract infection, nonhealing wounds). Oral antispasmodics can be weaned before trial if a goal is to eliminate them. The standard baclofen test dose is a 50-mcg bolus, 25 mcg in very small children or patients who rely on spasticity for mobility. Patients unresponsive to the standard dose may require 75 mcg or 100 mcg; 24 hours should elapse between bolus doses. Cardiopulmonary parameters should be checked frequently during the first two hours postinjection, and spasticity measures assessed at least twice within four hours. Observation continues until the patient is stable and recovers from hypertonia. Adverse events include spinal headaches, nausea/vomiting, urinary retention, hypotension, seizures, drowsiness/sedation, respiratory depression, and coma. Before implantation, team members must discuss starting dose, drug concentration, delivery mode, pump size and location, and catheter tip placement. Patients/caregivers should understand the commitment necessary for ITB therapy. CONCLUSIONS: Screening helps identify appropriate candidates for ITB.
INTRODUCTION: Intrathecal baclofen (ITB) screening assesses response to a test dose of ITB on spasticity and function and identifies adverse reactions. METHOD: An expert panel consulted on best practices after conducting an extensive literature search and conducting an online survey. RESULTS: A successful trial may confirm predetermined goals, which may include improved mobility/positioning, decreased time/improved independence for activities, less home exercise, better wheelchair tolerance, decreased caregiver time, improved sleep, and reduced pain, or may modify goals and expectations. Individuals should not be tested in the presence of active medical issues (e.g., MS exacerbations, active urinary tract infection, nonhealing wounds). Oral antispasmodics can be weaned before trial if a goal is to eliminate them. The standard baclofen test dose is a 50-mcg bolus, 25 mcg in very small children or patients who rely on spasticity for mobility. Patients unresponsive to the standard dose may require 75 mcg or 100 mcg; 24 hours should elapse between bolus doses. Cardiopulmonary parameters should be checked frequently during the first two hours postinjection, and spasticity measures assessed at least twice within four hours. Observation continues until the patient is stable and recovers from hypertonia. Adverse events include spinal headaches, nausea/vomiting, urinary retention, hypotension, seizures, drowsiness/sedation, respiratory depression, and coma. Before implantation, team members must discuss starting dose, drug concentration, delivery mode, pump size and location, and catheter tip placement. Patients/caregivers should understand the commitment necessary for ITB therapy. CONCLUSIONS: Screening helps identify appropriate candidates for ITB.
Authors: Jia W Romito; Emily R Turner; John A Rosener; Landon Coldiron; Ashutosh Udipi; Linsey Nohrn; Jacob Tausiani; Bryan T Romito Journal: SAGE Open Med Date: 2021-06-03