521 - Gradual Progression from Partial to Complete Baclofen Pump Catheter Occlusion: A Case Report

The patient presented to an acute care hospital with a 2 day history of worsening spasticity, pruritus and abdominal pain. Their spasticity had been managed by intrathecal baclofen pump for many years and the last refill was 4 days prior to presentation.

Discussions:

On initial assessment, the patient appeared uncomfortable, itchy, and exhibited poorly controlled spasticity. Due to concern for baclofen withdrawal, a bolus was administered via the intrathecal pump, resulting in initial symptom improvement. Oral baclofen and an aggressive bowel regimen were also initiated. Over the following week, the patient underwent daily evaluations, with incremental increases in pump rate and multiple bolus trials. While the pruritus resolved, the spasticity persisted. The pump rate was increased by 33% to 1021.9 mcg/day, without significant improvement. CT imaging confirmed appropriate catheter placement. On initiation of a catheter dye study, baclofen could not be aspirated, indicating complete catheter occlusion. Review of the patient’s history revealed that the pump rate had been gradually increased over the prior six months with worsening symptoms. This information, combined with the patient’s presentation and confirmed catheter obstruction is consistent with progression of partial to complete baclofen pump catheter occlusion.

Conclusions:

This highlights an unusual case of progressive catheter occlusion. Occlusion of the catheter over time was reflected by the patient’s gradual worsening of spasticity which ultimately lead to repeated up-titration of baclofen pump rate. Ultimately, complete occlusion occurred, resulting in classic signs of baclofen withdrawal. This case underscores the importance of considering progressive catheter occlusion as a potential cause of worsening spasticity in patients managed by intrathecal baclofen pumps.