Kids Health Info

Intrathecal baclofen 2 Trial dose

  • Intrathecal baclofen is a treatment used for children with spasticity or dystonia. Baclofen is a medicine that tells the muscles to relax. Intrathecal baclofen is baclofen that is given into the space around the spinal cord. This is done through a permanent, surgically implanted pump that is placed in the abdomen (tummy) with a tube that goes to the spinal cord. (See Kids Health Info factsheet: Intrathecal baclofen 1 Introduction).

    Why have a trial?

    Intrathecal baclofen therapy (ITB) requires a major operation and a commitment to a lot of extra care for your child. ITB is not right for every child and the effect baclofen has is different for each child. Testing how baclofen will work on your child will help you and your child's doctors decide if it is the right treatment. 

    Test dose or catheter trial?

    There are two types of trial:

    1. Bolus - also called a single dose test trial.
    2. Catheter trial -  a five day trial, also called a tube trial.

    It depends on your child's diagnosis whether they need a single dose test or the five day catheter trial. Your child's doctor will explain to you which is best for your child and why.

    1: Bolus trial:

    • Your child will be admitted to a ward, usually just for one day. They can usually go home at the end of the day and do not need to stay overnight.
    • Your child will have a general anaesthetic and will be given an injection (also known as lumbar puncture) of baclofen into the space surrounding their spinal cord. This happens in the Day of Surgery Centre. When your child has woken from the anaesthetic, they will be taken to the ward.
    • On the ward, nurses will care for and observe your child while the effects of the anaesthetic wear off. Effects include drowsiness, nausea and vomiting.
    • About every two hours after the lumbar puncture a doctor, physiotherapist and occupational therapist will assess your child to see what effect the baclofen has had on their muscles. 
    • As your child will be under anaesthetic when they have the procedure, they should not have any pain. During the day, they may develop a headache. This is a side effect of the lumbar puncture.
    • If your child is awake, has eaten some food and is feeling well they can usually be discharged home in the afternoon of the procedure. Some children may have some side effects from the anaesthetic (such as vomiting). If your child has any side effects, they will need to stay overnight in hospital for further observation.
    • If the trial is successful and your child responds well to the baclofen, an appointment will be made for you with a neurosurgeon to discuss the option of a pump and all that the procedure involves.

    2: Catheter (tube) trial:

    • Your child will need an operation to have a tube placed in the spine. The tube is joined to an access port (similar to a rubber cork) that sits just under the skin.

    cathetertrial_300

    • After the operation, a needle will be inserted through your child's skin into the access port. This needle is joined to long tubing and a small pump. This pump will deliver the baclofen into your child's spine.
    • Children having a catheter trial may have some pain from the surgery. They will be given pain relief medicine and staff will help make sure they are comfortable. 
    • Your child will be in hospital for at least five days.
    • If you and the doctors decide that your child would benefit from baclofen treatment, your child will go back to theatre and have a baclofen pump attached to the catheter that is already in their spine. This may happen at the end of the five days, or you may go home first and come back later to have the operation. For more information on the pump see Intrathecal baclofen 3: The ITB pump.

    Follow-up

    If your child's trial was considered successful, you will have an appointment with a neurosurgeon to discuss how the pump works, what the operation involves and when your child might get a pump. Many factors influence when your child might have a permanent pump implanted.

    If the trial was not successful your doctors will discuss with you alternative treatments for spasticity and dystonia.

    Key points to remember

    • There are two types of trial. Your doctor will talk to you about which one is best for your child and why.
    • Baclofen therapy is not suitable for every child and a trial will help you and your doctors decide if it is right for you.
    • Having a trial does not mean your child is definitely going to get a pump. There are many factors influencing the decision to get a pump and everything will be discussed with you before any decision is made.

    More information

    Contact

    The Royal Children's Hospital
    T: (03) 9345 5522
    A Baclofen doctor is on call 24 hours a day, seven days a week. Call the main hospital number and ask for the on-call developmental medicine consultant OR the on-call rehabilitation consultant, depending on which is your child's primary baclofen team.

     

    Developed by the RCH Department of Developmental Medicine in consultation with the Departments of Neurosurgery, Paediatric Rehabilitation, Orthopaedics and Physiotherapy. Many thanks to the parents who were involved in the development and review of this fact sheet. First published in July 2007. Updated November 2010.

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Disclaimer 
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.