Cerebral Origin Spasticity:

Special Considerations:

  • Hydrocephalus s/p VP shunt (no contraindication if stable). VP shunt may change CSF flow dynamics and could change ITB dose requirements.
  • Seizures (no contraindication if controlled).
  • Other procedures (g-tube is no contraindication).
  • Medical problems / conditions (scoliosis may make positioning difficult, active infection or decubitus is a contraindication).
  • Prior procedures - no absolute contraindication.
  • Patients with significant upper body weakness - assess individually.
  • Flexibility of dosing with pump - benefit with varied programming possibilities.
  • Upper limb spasticity - can be assessed.
  • Catheter position can be placed higher than usual (T-10) to high thoracic level to achieve higher concentration of ITB in cervical region to treat upper limb spasticity more effectively.
  • Bulbar Spasticity - can be possibly addressed.
  • Trigeminal Neuralgia - can be helped (personal experience MG).
  • MRI Scan - can be safely performed. Pump should be turned off. There appears to be long change in pump function after being turned back on, it is safe for patient (no withdrawal, no complications related to pump being in magnetic field when off) - (personal experience MG and RG).

    • This x-ray shows the ribs, thoracolumbar spine with scoliosis, pump in the lower right corner (left lower abdominal quadrant), staples over spine, g-tube right above pump (left upper abdominal quadrant) with gas bubble from stomach with g-tube crossing over down to the bottom right, and on the left side of the picture - seen as a white vertical line is the peritoneal part of a ventriculo-peritoneal shunt tube (vp shunt). All in the same abdomen is itb pump, g-tube, and vp shunt.