Raunak Garg, a 40-year old engineer, met with an accident which made him paralyzed. Prompt surgery performed by Dr. Ketan Khurjekar could regain stability and partial power. But he developed spasticity.
Surgery associated Spasticity allowed him to stand while doing neuro-physiotherapy rehabilitation but at the same time used to give severe muscle cramps, leg pain. Ill effects of spasticity were de-nerving.
Characterized by extreme muscular stiffness and painful muscle spasms, spasticity is a debilitating movement disorder which reduces quality of life of patients to a large extent. Not just muscular relief, pain management in spasticity becomes a very important part of treatment. But unfortunately medications for spasticity such as Baclofen, apart from being less effective when taken orally, also bring along a series of side-effects.
After the surgery performed by Dr Ketan Khurjekar, Raunak regained power in upper limb but lower limbs were spastic. Patients with spasticity not only suffer from severe contractures and deformities but also severe pain that debilitates them5. Research studies have found that chronic pain is an extremely prevalent condition. A variety of international studies have estimated that between 10.1 -55.2 percent of population are afflicted with pain1. Needless to say, pain is directly related to quality of life. It has been found that prompt and effective pain control can prevent needless suffering, and may significantly improve patients’ quality of lives.
According to experts, spasticity cannot be completely treated but can be effectively managed. While a variety of oral and parenteral medications have been employed to manage spasticity, baclofen has emerged as most useful oral medication in its management. Baclofen helps in inhibition of neuro reflex pathways and works at the spinal cord level after crossing blood brain barrier5.
However, baclofen has been strongly associated with side-effects, such as sedation, dizziness, weakness, and dizziness, similar to those experienced by Raunak when he was put on the medication.
When taken in high doses, baclofen causes adverse side-effects. Prolonged use of this drug can even lead to resistance for its reaction in the human body. However, in spite of side effects, baclofen continues to be at the forefront of managing severe spasticity, with most patients responding well to first line of treatment with baclofen. The need of the hour is an innovative drug delivery system offering an infallible solution to this problem.
Recently, an Intrathecal Pump for localised drug delivery intended for managing conditions such as spasticity has been introduced in the market. Earlier such modalities of treatment were not available in india. Now they are available and also less expensive as compared to western counterparts.
“Intrathecal Pump Baclofen (ITB) delivery has been shown to be useful in the majority of patients to treat severe or intractable spasticity and dystonia leading to a decrease in muscle spasms, pain, and an increase in functional motor activity and control. Moreover, ITB administration helps maximize Baclofen’s effects and lessens its side effects”, says Dr Ketan Khurjekar
The innovative device is an automatic medicine pump, fitted beneath the skin of the patient. It is connected to a catheter which goes to the spine and ends in the intrathecal space, where it releases the drug in small doses, such as 2 or 3 mg, directly into the spinal cord.
Experts say that delivering the drug directly into the intrathecal space proves to be incredibly advantageous, as targeted delivery of the drug improves the patient’s condition by relieving pain, reducing spasms, improving control and function along with least side-effects. Studies on spasticity of spinal origin have shown that intrathecal pump baclofen therapy significantly reduces spasticity.2
The pump is designed to deliver minuscule amount of drug right in the spinal cord, from where it directly reaches the brain, thereby not just dramatically increasing the effect of the drug and functional motor ability but also almost entirely eliminating the possibility of side-effects on the rest of the body.
This highly efficient and effective drug delivery system can be used for other diseases and conditions as well, requiring multifocal pain management. For instance, Intrathecal Pump is also employed to deliver morphine, a drug used for managing chronic pain and intractable cancer pain.
Dr Ketan Khurjekar stated that drug therapy using Intrathecal pump requires active involvement of the patient with the medical team, along with regular scheduled return visits to the clinic for refills.
So, with innovations such as Intrathecal pumps taking localised drug delivery to a higher level, it is time to live with spasticity with a positive approach in a more independent manner.
3. Penn, RD. Intrathecal baclofen for spasticity of spinal origin: seven years of experience.
J Neurosurg. 1992;77(2):71-77.
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