Baclofen pumps are a transformative
therapy but they don’t come without risk. In this video I’m going to be discussing
the risks of baclofen overdose withdrawal and infection. If you, or
someone that you love suffers from severe spasticity, and may have a
baclofen pump or it’s considering one then this video is for you. Don’t go away
because that learning starts right now! Learn about MS with me
Aaron Boster. I started this channel to help my own MS clinic patients learn
between clinic visits, and it’s my hope that through these videos i can help you
learn too. Today’s video continues an ongoing discussion surrounding severe
spasticity and the management using intrathecal baclofen pumps. I’ll post a
link up above and in the description down below of earlier videos from this
series where I talk about who’s the right candidate for a pump, and what it
means to go through an ITB test dose, and what it’s like using a pump. This video
is going to focus on risk. Specifically three risks that of baclofen overdose,
baclofen withdrawal and infection. Topic number one is baclofen overdose. When you
receive too much intrathecal baclofen now the first thing that we notice when
there’s an overdose is that you might be too floppy. the goal of the pump is to
loosen stiff muscles but if you’re getting too much baclofen that can be
overboard and so one of the first things we see is, “hey doc! you took away too much
tone and I’m feeling kind of floppy!” and that’s an easy one to fix. You just turn
the pump back down. But overdose is a spectrum with “I’m a little floppy” on one
end as you move through the spectrum people can become sedated and confused
they can even ultimately lose consciousness and go into a coma. Severe
risks include seizure and death, and I want to point out that this is a
spectrum. I’ve been managing baclofen pumps now for almost a decade and we
don’t see, thank God, death and coma. I just share that with you
because I want you to understand the spectrum of what could happen. Now a key
takeaway when thinking about overdose is that it’s almost always related to
something that a human did. A procedure on the pump whether it be a refill or a
reprogramming of the pump where maybe something wasn’t put in correctly, and
this is an important tip because someone with a baclofen pump who is getting
really sedated and is really floppy you want to ask the question, “When were you
last in clinic? When did you last get refilled ? When did you last have a
program change?” and this will typically clue you in. How do you manage baclofen
overdose? Well the first thing is you need to get to a provider right away and
so you’re going to call your provider who takes care of your pump or you’re
gonna go to the emergency room and typically the way that we deal with it
is rather simple: we simply lower the dose. In the severe
case, we can actually remove spinal fluid either through the pump or through a
lumbar puncture, and when you pull the spinal fluid off you’re actually pulling
off the baclofen and then the effects of the overdose go away. Topic number two is
intrathecal baclofen withdrawal. By a way of quick review, the baclofen pump holds
liquid baclofen and this is surgically implanted inside you with a catheter, a
tube, also inside your body connecting the pump to your back, into the sac the
spinal cord sits in. And this system delivers drug targeted to the spinal sac.
It baths the spinal cord in liquid baclofen. If there’s a sudden abrupt
arrest of that, if it suddenly stops delivering baclofen, then human being can
go through a withdrawal, and you can have this happen because of a multitude of
things: the pump could run empty, the catheter could become dislodged or
cracked, or a break or the pump could malfunction, and the symptoms the signs
of withdrawal again are a spectrum on one end we can see just an increase in
tone, they get stiff again and if you move on the spectrum we use a pneumonic
“intrathecal baclofen (ITB)” is the name of this therapy and the pneumonic through
withdrawal is also “ITB”itchy twitchy bitchy. Let me explain
what I mean people who are going through withdrawal
will start itching everywhere, even though they don’t have a rash. And that’s
a tip-off. Twitchy is an off-color way of saying they have a return of their
pathologic tone. They’re having cramps they’re having spasms or having stiff
limbs. And bitchy is an off-color way of reminding us that people going through
withdrawal become unusually irritable. Now again going back to the spectrum as
you move forward and it gets more severe it can ultimately include things like
seizures, kidney failure, coma and death. And again I’m not saying that to you
because this happens frequently, not at all, but I just want you to understand
the spectrum and I also want you to understand the seriousness of receiving
the baclofen pump. if you develop itchy twitchy bitchy you have to get yourself
to the emergency department or to your provider. I actually provide my patients
with oral baclofen, a bottle of oral baclofen. And I want them to carry this with them because if they start to have signs or symptoms of withdrawal I want them to
take oral baclofen and call me. Now the third is infection, and infection is
almost always surrounding the time of the surgical implant because of the
surgery and so there can be perioperative infection, and this has
everything to do with the skills of the surgeon and with wound healing and care
afterwards and so it’s critically important of course to follow the
instructions of the surgeon and make sure that you have the follow-up that
you need to make sure that your incisions look okay
and if when you have infection this can become very serious because the the
baclofen pump connects into your central compartment and so again you don’t want
to blow it off and you need to go to see your provider immediately. I’ve just
reviewed some scary stuff back with an overdose, withdrawal and infection I want
to let you know that your baclofen provider should be very, very well
equipped to deal with all of this. My team certainly is. we have handled
situations very eloquently because we know what to look for and we educate our
patients and that’s what I’m trying to do with you right now.
I want you to be aware that this can happen so that you know what to look for
I want you to not be scared, and I want the knowledge to help you and making
sure that you know what’s going on and what you need to do and who you need to
call once again my name is Aaron Boster and thank you for learning about
multiple sclerosis and spasticity with me. This is part of a
larger series that I’ve been doing on intrathecal baclofen pumps and I hope
that you found it helpful. If you like this video when you’d like to see more
please consider subscribing to the channel and make sure to click that
notifications button so you don’t miss any of my future content.Until my next
video, take care!