Spasticity / Movement Disorders
Ryane E. Adams, N/A, MD
Resident
University of Texas at Houston Health and Science Center
Houston, Texas, United States
Bryson Houston, BS
Medical Student
University of Pennsylvania
Philadelphia, Pennsylvania, United States
Ryane E. Adams, N/A, MD
Resident
University of Texas at Houston Health and Science Center
Houston, Texas, United States
32 year-old male with PMH of severe TBI resulting in hypoxic-ischemic brain injury, bilateral spastic hemiplegia, and dystonia requiring ITB pump. The patient underwent a positive pump trail with subsequent ITB pump placement with significant improvement in spasticity and tone. The patient initially presented to an outside hospital due to concern for status epilepticus. His course was complicated by paroxysmal sympathetic hyperactivity (PSH) for which the patient's ITB pump was increased. While undergoing rehabilitation, the patient continued to have poorly controlled tone prompting further investigation. The patient underwent catheter access port study. Pump malfunction was noted due to occlusion from adhesions and significant scar tissue at the catheter attachment point. The whole ITB system was replaced.
Discussions:
The presentation of intrathecal baclofen withdrawal is well documented in literature. In 2024, Medtronic issued an “Urgent Medical Device Correction,” related to unexpected tissue in the catheter connector. When there is concern for ITB pump system dysfunction, a focused history specifying the timing of symptom onset, the current baclofen dose and recent dosing adjustments, identification date of pump implantation, last pump battery exchange, and most recent refill should be obtained. From there, the pump should be interrogated and a catheter access point study should be performed.
Conclusions:
This case represents the complexity of diagnosing ITB pump malfunction when there are multiple confounding medical variables present and the need for interpreting what we see in a paper into what we see in the clinical setting. Despite ITB therapy availability since 1992, little is understood about troubleshooting a potential problem in the system. This difficulty can result in missed or delayed diagnosis of ITB pump withdrawal. More research and education to providers at all levels is necessary.
