Intrathecal baclofen trial question

[GottaHaveIt]

Hey all,

When doing these trials do you have a specifc level that you will target, such as L2-3 or does it not tend to matter?

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[deleted131481]

What are you treating? That sounds fine for lower limb, but may want to go a little higher (T12 - L1) for where you anticipate implant tip would be.

 

[Orin]

Best Practices for Intrathecal Baclofen Therapy: Screening Test - PubMed

Screening helps identify appropriate candidates for ITB.

pubmed.ncbi.nlm.nih.gov

IT access should generally be done in a cistern, so I would counsel you to stay at or below the conus unless you also want to treat the spinal cord injury from an intraparenchmyal injection/needle. You could target the cervical cistern, but I'm not sure you want to deal with the small amount of thoracic CSF.

Regardless, 50-75 mcg of baclofen spreads around pretty well and gets stuck in the CSF. It'll hit the legs/back first if you access low, but within 2 hours or so, you'll know for things a little higher up.

 

[deleted131481]

Best Practices for Intrathecal Baclofen Therapy: Screening Test - PubMed

Screening helps identify appropriate candidates for ITB.

pubmed.ncbi.nlm.nih.gov

IT access should generally be done in a cistern, so I would counsel you to stay at or below the conus unless you also want to treat the spinal cord injury from an intraparenchmyal injection/needle. You could target the cervical cistern, but I'm not sure you want to deal with the small amount of thoracic CSF.

Regardless, 50-75 mcg of baclofen spreads around pretty well and gets stuck in the CSF. It'll hit the legs/back first if you access low, but within 2 hours or so, you'll know for things a little higher up.

Better answer. I don't do pump trials and implants, but I've inherited a number of pumps that I manage. Comment above was based on where I see catheter tip - not necessarily best practice.

 

[painfree23]

We still doin this stuff??

 

[NJPAIN]

I'm no expert but back in academics 20+ years ago and even further back in history during fellowship would be asked to do this frequently for SCI, etc. Initially all single shot trial via lumbar access at L3-4 or L4-5 (no imaging). Later started using a catheter to facilitate giving serially higher doses over a few days. Never requested to target any higher.

 

[Orin]

We still doin this stuff??

Baclofen for spasticity has better data than anything else we do