Intrathecal pump
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An intrathecal pump is a medical device used to deliver very small quantities of medications directly to the spinal fluid of a human being. Medications such as baclofen, morphine, or ziconotide may be delivered in this manner to minimize the side effects often associated with the higher dosages commonly found in oral medications of the same type.
People with spastic diplegia or other forms of spasticity, or people in intolerable pain and nociception, who cannot tolerate side effects of the higher-dose oral medications of the same medication type, are potential candidates for that medication being administered via an intrathecal pump. In about 5% of patients, the intrathecal baclofen route has no effect on the nervous system.[citation needed]
The intrathecal pump consists of a metal pump which stores and delivers the medication, and a catheter which delivers the medication from the pump to the intrathecal space in the spine where the medication takes effect. Two types of pumps are available: a constant rate pump delivers the medication at a constant rate, and a programmable pump delivers the medication according to a rate determined by a programmable computer.
The implantable medical device requires a surgical procedure; a surgeon usually performs a trial intrathecal injection or a temporary intrathecal pump to determine if the medication works to begin with, and thus if a pump is appropriate. A permanent intrathecal pump is then implanted if the patient derives at least 50% improvement in his or her symptoms. However, for patients suffering spasticity, a trial dose is usually not administered, because "In clinical studies, ITB Therapy reduced spasticity in 97 percent of people with severe spasticity due to multiple sclerosis and spinal cord injury, and in 86 percent of people with severe spasticity due to cerebral palsy or brain injury." ['Medtronic ITB™ Therapy Fact Sheet' accessed 02/08/12]
Despite the potential benefits of the intrathecal pump, complications from the implantation are major when they occur, and can happen at any time, even when the initial implantation is successful for several years in a row. Complications from the surgery itself are actually very rare in the present day — infection and excessive bleeding during the surgery, spinal cord injury during the surgery, or catheter fracture or migration on the operating table do exist as risks, but typically do not happen. However, as standard operating procedure, and to minimize the chance for mishap, the entire pump is replaced every ten years.
[edit] References
- Penn, RD et al. (1989). "Intrathecal baclofen for severe spinal spasticity". New Engl J Med 320 (23): 1517–1521. doi:10.1056/NEJM198906083202303. PMID 2657424.
"Medtronic ITB™ Therapy Fact Sheet" http://wwwp.medtronic.com/Newsroom/LinkedItemDetails.do?itemId=1101744234323&itemType=fact_sheet&lang=en_US
[edit] External links
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