Posted - February 2017 in Living with HSP - Management & Treatment News
Assessment and testing
In this article, Board member of the SP Foundation in the USA, HSPer and medical doctor, Malin Dollinger, discusses assessment and testing for a baclofen pump.
Have you considered getting tested for the effectiveness of a baclofen pump or are curious about what is involved?
The correct procedure for a test injection is to insert a small catheter, using a local anesthetic, into the subarachnoid space (where the permanent catheter will go, if you decide to do this). This is inserted into the skin of the lower back, much the same place as a spinal anesthetic is placed.
Then the first test dose of Baclofen e.g. 50micrograms, is given through the catheter. It may produce the desired effect, reducing spasticity and improving walking, or may have an excess effect, rendering you temporarily paralyzed (for an hour or two, till it wears off). If that happens, the correct procedure is to repeat the test using a 25microgram dose. This is again through the catheter, already correctly placed. If paralysis occurred with the 50microgram dose, the 25microgram may produce the desired reduction in spasticity, to allow walking.
What happened to me, previously, is that they did not insert a catheter, but simply a needle, then injected the “test dose” of 50micrograms, which rendered me paralyzed. They said “I failed the test” and I never got the pump. Likely had they repeated the test using a half-dose of Baclofen, it might have produced exactly the desired effect.
Oral vs pump Baclofen
Same drug, same effect, but the oral dose is much much greater in order for a tiny part of that oral dose to get into the spinal cord/brain and produce the anti-spasticity effect. Problem is often that the large oral dose produces sleepiness, confusion, tiredness, etc, which may not be tolerable, even if the walking/spasticity is better. The advantage of the tiny pump dose is that it goes directly where it needs to work, and doesn’t produce the “whole body” side effects sometimes found with the oral medication.
Malin Dollinger, M.D./SPG4