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Intrathecal pump

J Voirin, I Darie, D Fischer, A Simon, I Rohmer-Heitz, F Proust
INTRODUCTION: Motor cortex stimulation is a well-known treatment modality for refractory neuropathic pain. Nevertheless, some cases of therapeutic failure have been described but alternative therapies for these cases are rarely reported. CASE REPORT: The patient presented with neuropathic pain in his right arm due to a cervical syrinx which was surgically treated by a shunt in 2003 with no clinical improvement. As alternative therapy, after an evaluation by repetitive magnetic transcranial stimulation with significant benefit, motor cortex stimulation was successfully implanted in 2004...
October 19, 2016: Neuro-Chirurgie
Baohua Yue, Ron Brendel, Amelia Lukitsch, Thomas Prentice, Brian Doty
BACKGROUND: Commercial baclofen formulations used with infusion pumps are available at therapeutic concentrations of 0.5-2.0 mg/mL. However, patients who receive higher daily doses of baclofen may benefit from products with greater baclofen concentrations since their refill frequency would be reduced (up to a maximum of 180 days). We evaluated baclofen solubility, baclofen 3 mg/mL intrathecal (IT) formulation stability, and chemical and physical compatibility with Medtronic SynchroMed(®) II and Codman Medstream(®) programmable IT infusion pumps...
October 21, 2016: Neuromodulation: Journal of the International Neuromodulation Society
Peter E Konrad, John M Huffman, Lisa M Stearns, Robert J Plunkett, Eric J Grigsby, E K Stromberg, Mollie P Roediger, Michelle D Wells, Todd W Weaver
OBJECTIVES: The ISPR was initially created to monitor the product performance of Medtronic implanted intrathecal drug infusion and spinal cord systems available in the United States. MATERIALS AND METHODS: Data were collected from 50 representative sites implanting and following patients with intrathecal drug delivery systems across the United States between August 7, 2003 and January 31, 2014. Device performance over time was estimated using life table survival methods...
October 12, 2016: Neuromodulation: Journal of the International Neuromodulation Society
Rodrigo Hasbun
Nosocomial meningitis can occur in association with central nervous system (CNS) devices such as cerebrospinal shunts or drains, intrathecal pumps, and deep brain stimulators and carry substantial morbidity and mortality. Diagnosing and treating these infections may be challenging to physicians as cerebrospinal fluid cultures may be negative due to previous antibiotic therapy and cerebrospinal abnormalities may be secondary to the primary neurosurgical issue that prompted the placement of the CNS device (e...
November 2016: Current Infectious Disease Reports
Flavie Frémondière, Franck Lacoeuille, Avigaëlle Sher, Olivier Couturier, Philippe Menei, Isabelle Richard, Mickaël Dinomais
Intrathecal baclofen is now an admitted treatment of generalized and disabling spasticity. Technical incidents of the device remain frequent, mainly due to catheter problems. Consequences can be abrupt with life-threatening withdrawal syndrome or progressive with spasticity reappearance. In case of progressive withdrawal syndrome, the assessment process has to be meticulous to find the cause of inefficiency and to avoid useless revision surgery. This assessment includes medical examination, radiographs, intrathecal baclofen bolus, after what, if no conclusion can be drawn, a more invasive imaging exam has to be performed...
September 2016: Annals of Physical and Rehabilitation Medicine
W Porter McRoberts, Catalina Apostol, Abdul Haleem
UNLABELLED: Complex regional pain syndrome (CRPS) presents a therapeutic challenge due to its many presentations and multifaceted pathophysiology. There is no approved treatment algorithm and clinical interventions are often applied empirically. In cases of CRPS where symptoms are localized to an extremity, a targeted treatment is indicated. We describe the use of intrathecal bupivacaine monotherapy, delivered through a retrograde catheter, in the treatment of CRPS affecting the lower extremity...
September 2016: Pain Physician
Emanuele Piraccini, Ruggero M Corso, Helen Byrne, Morena Calli, Stefano Maitan
No abstract text is available yet for this article.
September 27, 2016: Minerva Anestesiologica
Neil V Mandalaywala, Young Il Seo, Heidi N Fusco
No abstract text is available yet for this article.
September 2016: PM & R: the Journal of Injury, Function, and Rehabilitation
Samantha A Benjamin, Henry S York
No abstract text is available yet for this article.
September 2016: PM & R: the Journal of Injury, Function, and Rehabilitation
Timothy J Kovanda, Ecaterina Pestereva, Albert Lee
INTRODUCTION: Intrathecal baclofen pumps are valuable treatment options for those with cerebral palsy. Although subfascial baclofen pump placement is generally preferred over a subcutaneous pump placement due to lower infection rates, rare complications can occur with the subfascial approach such as pump migration. CASE PRESENTATION: The authors here describe a case of baclofen pump migration into the peritoneal cavity of a 26-year-old male patient with cerebral palsy, shunted hydrocephalus, and epilepsy...
June 2016: Anesthesiology and Pain Medicine
Hussam Abou Al-Shaar, Ahmed Alkhani
BACKGROUND: Intrathecal baclofen (ITB) therapy using a programmable battery-based pump is a well-recognized option in the treatment of patients with refractory spasticity. Improvements in clinical scale scores for muscle spasticity among this heterogeneous group of patients may not reflect the functional benefits of this therapeutic option. The aim of our study is to report the efficacy of ITB therapy by setting the patient's compliance at the 2-year follow-up after pump implantation as an indicator of treatment efficacy, as appreciated by the patients or their caregivers...
2016: Surgical Neurology International
Gerald S Bilsky, Michael Saulino, Michael W O'Dell
No abstract text is available yet for this article.
August 2016: PM & R: the Journal of Injury, Function, and Rehabilitation
I Elias Veizi, Salim M Hayek, Michael Hanes, Ryan Galica, Sivakanth Katta, Tony Yaksh
BACKGROUND: Intrathecal drug delivery therapy has been used effectively in treating patients with intractable chronic pain. The development of an intrathecal catheter tip granuloma (ICTG) related to delivery of intrathecal opiates is a relatively infrequent, but potentially devastating complication. While there are many morphine-related ICTG cases described, reports of hydromorphone-related ICTG are limited. In addition, studies suggest a strong correlation between the use of higher doses and concentrations of intrathecal opiates and ICTG formation...
October 2016: Neuromodulation: Journal of the International Neuromodulation Society
Julia Prusik, Charles Argoff, Sophia Peng, Julie G Pilitsis
BACKGROUND: Ziconotide use in intrathecal drug therapy (IDT) has been limited by dosing related side effects. We examine our experience with ziconotide as a first line IDT monotherapy in patients with chronic pain and present our low and slow dosing algorithm aimed at reducing these patient experienced side effects while adequately managing pain. METHODS: We retrospectively reviewed demographics, dosing, and outcomes of 15 consecutive patients with complete three-month data sets implanted with intrathecal pain pumps more than three years utilizing ziconotide as a first-line monotherapy...
August 5, 2016: Neuromodulation: Journal of the International Neuromodulation Society
Michael Saulino, Michael Turner, Keith Miesel, Felicia R Cochran, Katherine Stromberg, Elizabeth Fehrmann, Mary Markert, Robert Spencer
OBJECTIVE: The catheter status of patients who presented with loss of intrathecal baclofen (ITB) therapy effectiveness was investigated using measurements of cerebrospinal fluid (CSF) pressure transmitted through the catheter fluid path to the pump. The aim of the study was to estimate the appropriate threshold separating catheter complications from "normal" catheter function, and to compare catheter status based on CSF pressure with the clinical diagnosis. METHODS: This was a prospective, masked nonsignificant risk, research study...
August 1, 2016: Neuromodulation: Journal of the International Neuromodulation Society
Michael Saulino, David J Anderson, Jennifer Doble, Reza Farid, Fatma Gul, Peter Konrad, Aaron L Boster
INTRODUCTION: Troubleshooting helps optimize intrathecal baclofen (ITB) therapy in cases of underdose, overdose, and infection. METHODS: An expert panel of 21 multidisciplinary physicians currently managing >3200 ITB patients was convened, and using standard methodologies for guideline development, created an organized approach to troubleshooting ITB. They conducted a structured literature search that identified 263 peer-reviewed papers, and used results from an online survey of 42 physicians currently managing at least 25 ITB patients each...
August 2016: Neuromodulation: Journal of the International Neuromodulation Society
Aaron L Boster, Susan E Bennett, Gerald S Bilsky, Mark Gudesblatt, Stephen F Koelbel, Maura McManus, Michael Saulino
INTRODUCTION: Intrathecal baclofen (ITB) screening assesses response to a test dose of ITB on spasticity and function and identifies adverse reactions. METHOD: An expert panel consulted on best practices after conducting an extensive literature search and conducting an online survey. RESULTS: A successful trial may confirm predetermined goals, which may include improved mobility/positioning, decreased time/improved independence for activities, less home exercise, better wheelchair tolerance, decreased caregiver time, improved sleep, and reduced pain, or may modify goals and expectations...
August 2016: Neuromodulation: Journal of the International Neuromodulation Society
Aaron L Boster, Roy L Adair, Judith L Gooch, Mary Elizabeth S Nelson, Andrea Toomer, Joe Urquidez, Michael Saulino
INTRODUCTION: Intrathecal baclofen (ITB) therapy aims to reduce spasticity and provide functional control. METHOD: An expert panel consulted on best practices. RESULTS: Pump fill and drug delivery can be started intraoperatively, with monitoring for at least eight hours. Initiate with the 500 mcg/mL concentration. The starting daily dose should be twice the effective bolus screening dose, or the screening dose if the patient had a prolonged response (greater than eight hours) or negative reactions...
August 2016: Neuromodulation: Journal of the International Neuromodulation Society
Juanmarco Gutierrez, Thais Federici, Bethany Peterson, Ray Bartus, Alexandre Betourne, Nicholas M Boulis
INTRODUCTION: Oral administration of riluzole is the only Food and Drug Administration-approved therapy for amyotrophic lateral sclerosis (ALS). However, per os riluzole therapy has shown modest efficacy and is limited by its negative impact on liver function. We hypothesize that intrathecal (IT) administration of riluzole will significantly improve drug efficacy by increasing local concentrations at targeted spinal cord segments, while circumventing peripheral toxicity. METHODS: A programmable infusion pump (SynchroMed II) connected to an IT catheter (Ascenda) was implanted into Göttingen minipigs to deliver a newly developed riluzole formulation...
August 2016: Neurosurgery
Matthias Morgalla, Marcos Fortunato, Ala Azam, Marcos Tatagiba, Guillherme Lepski
BACKGROUND: The assessment of the functionality of intrathecal drug delivery (IDD) systems remains difficult and time-consuming. Catheter-related problems are still very common, and sometimes difficult to diagnose. OBJECTIVES: The aim of the present study is to investigate the accuracy of high-resolution three-dimensional computed tomography (CT) in order to detect catheter-related pump dysfunction. STUDY DESIGN: An observational, retrospective investigation...
July 2016: Pain Physician
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