In these instances, the procedure will need to be aborted. This usually occurs when the child has rotatory scoliosis. Occasionally, we are unable to pass the lumbar puncture needle into the spinal fluid space. Extremely rare risks are spinal or epidural bleeding or trauma to the spinal nerve roots. Occasionally, headache may be experienced following lumbar puncture. As the Baclofen may still be in the child’s system, this is a good opportunity for caregivers to try transfers and cares in the home environment. The ITB team may videotape these examinations so that comparison can be made to previous assessments.Ĭhildren are typically discharged home during the early afternoon. This will involve a musculoskeletal examination of all four limbs, moving the child from lying to sitting and observing various activities such as dressing. The ITB doctors and therapists will review the child at two and four hours after the test dose to see what changes have occurred. During this time, we recommend that the child lies flat in bed. Typically, the effects of intrathecal Baclofen take two to four hours to be seen. If the child takes regular aspirin or blood thinning medication it is important to discuss this with the child’s doctor prior to the test dose being arranged. Morning medications, including oral Baclofen, should be given at usual times. This will be done in the Medical Day Unit, or in the operating theatres if general anaesthetic is required. The lumbar puncture will then be performed. If needed, the child will then be reviewed by the ITB team therapists for relevant assessments. The child will need to be admitted in the early morning. What to expectĪ lumbar puncture test dose is performed in hospital as a day procedure. To assist the child, pain relief, sedation or general anaesthesia may be given. A lumbar puncture can be an uncomfortable procedure. The Baclofen medication is then instilled through the needle before the needle is removed. A needle is placed through the skin on the back into the space between the spinal bones. The most common way of performing a test dose is by lumbar puncture. This allows us to assess the potential effectiveness of intrathecal Baclofen therapy for each individual child. ![]() As some children do not show any response to intrathecal Baclofen, a test dose is recommended prior to decision about surgical implantation. Baclofen medication is then delivered as a continuous infusion from the pump into the CSF. A catheter tunnels under the skin and enters into the cerebrospinal fluid (CSF) around the spinal cord. Intrathecal Baclofen therapy is the surgical implantation of a pump underneath the skin of the abdominal wall. In this way, side effects of the medication can be minimized. A much lower dose can therefore be used with a much greater effect. By infusing the Baclofen directly into the area around the spinal cord (the intrathecal space) it goes right to where it is needed. It is commonly taken in a tablet form however its effectiveness is limited as side effects become common as dose is increased. Baclofen works at receptor sites (called GABA) in the spinal cord and the brain. Baclofen is a muscle relaxant medication used to treat spasticity and dystonia.
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