Intrathecal Baclofen Administration in Severe Spasticity: Improving diagnosis and treatment of complications
Intrathecale toediening van baclofen bij ernstige spasticiteit: Verbetering van de diagnose en behandeling bij complicaties
Spasticity is the result of brain or spinal cord damage. For drug therapy, usually, oral baclofen is used. However, due to the blood-brain barrier, a small amount reached the site of action. When baclofen, with a small catheter and an implanted pump, is administered in the fluid space around the spinal cord (intrathecal administration), much more effective result with fewer side-effects can be achieved. The treatment method is used in severe spasticity.
In the event of failure of the therapy, there is a need for extended diagnostic procedures to exclude a drug delivery failure before deciding on exacerbation of the disorder or tolerance for the treatment. In clinic practice, diagnostic procedures seem to be too few, too limited or performed too late. These observations indicated a need for improved failure treatment, which motivated this thesis. In summary, all X-rays of the implanted drug delivery device were examined, and as a result, a checklist of a correct interpretation was developed. On the base of the missing visibility of part of the drug delivery system on X-ray, a method was developed with low radiation dose CT with 2D/3D reconstructions to visualize the whole system.
Furthermore, 70 contrast CT- and 36 isotope procedures of evaluation of the intrathecal drug delivery were examined and improvements were discussed. In the event treatment failure was caused by obstruction of the spinal cord fluid flow, with the restoration of this flow, clinical effect could be achieved again. Finally, the emergency treatment of an uncommon complication was discussed.
|Keywords||intrathecal, baclofen, complications, troubleshooting, treatment, radiography, catheter access port CT myelography, 111InDTPA scintigraphy|
|Promotor||F.J.P.M. Huygen (Frank) , A. van der Lugt (Aad) , B.S. Harhangi (Biswadjiet)|
|Publisher||Erasmus University Rotterdam|
|Note||For copyright reasons there is a (partial) embargo for this dissertation|
Delhaas, E.M. (2020, May 29). Intrathecal Baclofen Administration in Severe Spasticity: Improving diagnosis and treatment of complications. Erasmus University Rotterdam. Retrieved from http://hdl.handle.net/1765/127240