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Morozov IN, Nesterin KV. [Intrathecal baclofen therapy: a 30-year experience]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:96-102. [PMID: 38881022 DOI: 10.17116/neiro20248803196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
BACKGROUND The first pump for intrathecal administration of baclofen was implanted in 1984. Over thirty years, intrathecal prolonged infusion of muscle relaxants has occupied a worthy niche among all methods for correction of non-focal drug-resistant disabling muscle spasticity. However, this method has not become routine despite high awareness of specialists in Russia and abroad, as well as undeniable advantages for restoring the daily activity, improving the walking pattern and providing care and quality of life in people with limited mobility. This is due to scrupulous analysis of adverse events and accurate attitude towards its use. The purpose of this review was to systematize data on indications, selection criteria, pump implantation technique, subsequent patient management and treatment outcomes over a 30-year history. METHOD A review of national and foreign literature was performed. RESULTS AND CONCLUSION Prolonged intrathecal baclofen therapy is perspective for long-term treatment of severe spasticity interfering with quality of life and self-care if oral muscle relaxants are contraindicated or ineffective. This procedure is effective for impaired articulation, chewing and spastic pain syndrome. One can reduce the incidence of side effects via correct dosage of the drug, and tolerance to therapy can be reduced by timely elimination of problems with catheter.
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Affiliation(s)
- I N Morozov
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - K V Nesterin
- Ulyanov Chuvash State University, Cheboksary, Russia
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Grana E, Peschi L, Carda S. Intrathecal baclofen as an effective treatment for generalized dystonia in Wilson's disease. Eur J Phys Rehabil Med 2023; 59:653-655. [PMID: 37733332 PMCID: PMC10664811 DOI: 10.23736/s1973-9087.23.07960-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/10/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Elisa Grana
- Unit of Neuropsychology and Rehabilitation, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland -
| | - Livia Peschi
- Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Stefano Carda
- Unit of Neuropsychology and Rehabilitation, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- CANOSC - Canadian Advances in Neuro-Orthopedics for Spasticity Consortium, Kingston, ON, Canada
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Cho SR. Intrathecal Baclofen Therapy: Pros and Cons. Ann Rehabil Med 2023; 47:1-3. [PMID: 36800676 PMCID: PMC10020048 DOI: 10.5535/arm.23003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 02/21/2023] Open
Affiliation(s)
- Sung-Rae Cho
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
- Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Korea
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Biktimirov A, Pak O, Bryukhovetskiy I, Sharma A, Sharma HS. Neuromodulation as a basic platform for neuroprotection and repair after spinal cord injury. PROGRESS IN BRAIN RESEARCH 2021; 266:269-300. [PMID: 34689861 DOI: 10.1016/bs.pbr.2021.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Spinal cord injury (SCI) is one of the most challenging medical issues. Spasticity is a major complication of SCI. A combination of spinal cord stimulation, new methods of neuroprotection and biomedical cellular products provides fundamentally new options for SCI treatment and rehabilitation. The paper attempts to critically analyze the effectiveness of using these procedures for patients with SCI, suggesting a protocol for a step-by-step personalized treatment of SCI, based on continuity of modern conservative and surgical methods. The study argues the possibility of using neuromodulation as a basis for rehabilitating patients with SCI.
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Affiliation(s)
- Artur Biktimirov
- Department of Fundamental Medicine, School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia.
| | - Oleg Pak
- Department of Neurosurgery, Medical Center, Far Eastern Federal University, Vladivostok, Russia
| | - Igor Bryukhovetskiy
- Department of Fundamental Medicine, School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
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Blue R, Shah P, Spadola M, Lang SS, Yoo K, Hampton S, Chen HI. Instituting an intrathecal baclofen pump program at an academic institution. PM R 2021; 14:395-402. [PMID: 33543576 DOI: 10.1002/pmrj.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 01/14/2021] [Accepted: 01/26/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Rachel Blue
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Priyanca Shah
- Department of Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Spadola
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shih-Shan Lang
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kristen Yoo
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Stephen Hampton
- Department of Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - H Isaac Chen
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Pucks-Faes E, Dobesberger J, Halbmayer LM, Hitzenberger G, Matzak H, Saltuari L. Complications After Dual Placement of a Baclofen Pump and Ventricular Shunt in Individuals With Severe Brain Injury. Arch Rehabil Res Clin Transl 2020; 2:100082. [PMID: 33543105 PMCID: PMC7853326 DOI: 10.1016/j.arrct.2020.100082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To assess the complications of dual placement of an intrathecal baclofen (ITB) pump and a ventriculoperitoneal shunt (VPS) in people with severe brain injury. Design Case series. Setting Referral center, ambulatory, and hospitalized care. Participants Referred sample (N=9) composed of 5 men and 4 women with severe brain injuries (5 traumatic brain injuries, 3 subarachnoid hemorrhages, 1 intracerebral hemorrhage) and a mean disease duration of 6±4.5 years (range, 0.5-11.4y). Intervention Both systems (ie, an ITB device and a VPS system) were implanted in all participants. Main Outcome Measures We assessed the number and type of complications that occurred after implantation of the second system, as well as subsequent interventions. Results The ITB delivery system was implanted after the VPS system in 5 patients (ITB group), and the VPS system was the second implanted system in 4 groups (VPS group). Seven complications occurred in 7 patients after implantation of the second system, 4 in the ITB group and 3 in the VPS group. Three of the complications were drug-related, 2 were procedure-related, and 2 were device-related. The complication occurred within 4 days after implantation of the second system in 6 patients. Conclusions Complications are frequent in patients who undergo implantation of both an ITB delivery device and a VPS system. Drug-related complications were more common. Complications occurred more often when an ITB device was implanted as the second system. The critical period is the first 4 days.
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Affiliation(s)
| | - Judith Dobesberger
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria.,Rehabilitation Center Großgmain, Großgmain, Austria
| | | | | | | | - Leopold Saltuari
- Department of Neurology, Hochzirl Hospital, Zirl, Austria.,Research Unit for Neurorehabilitation in South Tyrol, Sterzing Hospital, Sterzing, Italy
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Vats A, Amit A, Cossar M, Bhatt P, Cozens A. Intrathecal baclofen trial using a temporary indwelling intrathecal catheter – A single institution experience. J Clin Neurosci 2019; 68:33-38. [DOI: 10.1016/j.jocn.2019.07.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/16/2019] [Accepted: 07/29/2019] [Indexed: 11/26/2022]
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8
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Pucks-Faes E, Matzak H, Hitzenberger G, Genelin E, Halbmayer LM, Fava E, Fritz J, Saltuari L. Intrathecal Baclofen Trial Before Device Implantation: 12-Year Experience With Continuous Administration. Arch Phys Med Rehabil 2019; 100:837-843. [PMID: 31030729 DOI: 10.1016/j.apmr.2018.09.124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/18/2018] [Accepted: 09/23/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report our experience using continuous intrathecal baclofen (ITB) administration prior to a possible ITB device implantation. DESIGN Retrospective open label study. Mean duration of follow-up 64 months. SETTING Primary-care and referral center, ambulatory and hospitalized care. PARTICIPANTS Patients (N=116) undergoing continuous ITB trials between 2006 and 2017. INTERVENTIONS Continuous application of baclofen via a temporary intrathecal catheter connected to an external pump. MAIN OUTCOME MEASURES Assessment of the modified Ashworth Scale and range of movement prior versus end of ITB trial. According to the Barthel Index, definition of high-level patients (60-100 scoring points) and low-level patients (0-55 scoring points). Calculation of the Rivermead Mobility Index in high-level patients prior versus end of ITB trial. Evaluation of occurring adverse events. RESULTS A total of 119 ITB trials were performed in 116 patients (78 men, mean age 41±16), 113 patients completed the trials (31 of 113 high level, 82 of 113 low level). The median modified Ashworth scale improved from 4 (interquartile range [IQR] 3-4) to 2 (IQR 1-2; P≤.001), the range of movement from 2 (IQR 1-3) to 3 (IQR 3-3; P≤.001). The Rivermead Mobility Index increased from 9 (IQR 6-12) to 10 (IQR 7-12.5; P=.004) in high-level patients. Eighty-eight out of 113 patients (78%) were appropriate candidates for ITB device surgery, 75 of 88 (85%) proceeded to an implantation. A total of 69 adverse events occurred in 57 of 119 trials (48%), 37 of 69 (54%) were drug related, 32 of 69 (46%) were procedure related, and 42 of 69 (61%) were minor. The ITB device was implanted in 69 of 75 patients (92%) at last follow-up. CONCLUSIONS Continuous administration of ITB is an effective and useful alternative to ITB bolus application during ITB screening period. Half of the patients experienced adverse events; the majority were minor events.
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Affiliation(s)
| | | | | | | | | | - Elena Fava
- Department for Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Josef Fritz
- Department for Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Leopold Saltuari
- Department of Neurology, Hochzirl Hospital, Zirl, Austria; Research Unit for Neurorehabilitation, South Tyrol, Bolzano, Italy
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Abstract
Intrathecal baclofen therapy is a well-established technique for spasticity management. This article briefly reviews the pharmacology of intrathecal baclofen as well as customary approach for utilization of this targeted drug delivery concept. Following these descriptions, four unusual presentations will be described, including the need for initial trialing, patient-directed boluses during chronic intrathecal baclofen therapy, use of medications other than baclofen for intrathecal therapy in spastic patients, and intraventricular baclofen delivery. These hypothetical cases are provided in an effort to expand the use of targeted drug delivery to larger population of spastic patients.
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Affiliation(s)
- Michael Saulino
- MossRehab, 60 Township Line Road, Elkins Park, PA 19027, USA; Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
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10
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Abbatemarco JR, Willis MA, Wilson RG, Nagel SJ, Machado AG, Bethoux FA. Case Series: Intrathecal Baclofen Therapy in Stiff-Person Syndrome. Neuromodulation 2018. [DOI: 10.1111/ner.12765] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Mary Alissa Willis
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, The Cleveland Clinic Foundation; Cleveland OH USA
| | - Robert G. Wilson
- Department of Neurology; Cleveland Clinic Foundation; Cleveland OH USA
| | - Sean J. Nagel
- Department of Neurosurgery; Cleveland Clinic Foundation; Cleveland OH USA
| | - Andre G. Machado
- Department of Neurosurgery; Cleveland Clinic Foundation; Cleveland OH USA
| | - Francois A. Bethoux
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, The Cleveland Clinic Foundation; Cleveland OH USA
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11
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Intrathecal Baclofen Therapy for the Control of Spasticity. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00072-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Yoon YK, Lee KC, Cho HE, Chae M, Chang JW, Chang WS, Cho SR. Outcomes of intrathecal baclofen therapy in patients with cerebral palsy and acquired brain injury. Medicine (Baltimore) 2017; 96:e7472. [PMID: 28834868 PMCID: PMC5571990 DOI: 10.1097/md.0000000000007472] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Intrathecal baclofen (ITB) has been known to reduce spasticity which did not respond to oral medications and botulinum toxin treatment. However, few results have been reported comparing the effects of ITB therapy in patients with cerebral palsy (CP) and acquired brain injury. This study aimed to investigate beneficial and adverse effects of ITB bolus injection and pump therapy in patients with CP and to compare outcomes to patients with acquired brain injury such as traumatic brain injury and hypoxic brain injury. ITB test trials were performed in 37 patients (19 CP and 18 acquired brain injury). Based on ambulatory function, CP patients were divided into 2 groups: 11 patients with nonambulatory CP and 8 patients with ambulatory CP. Change of spasticity was evaluated using the Modified Ashworth Scale. Additional positive or negative effects were also evaluated after ITB bolus injection. In patients who received ITB pump implantation, outcomes of spasticity, subjective satisfaction and adverse events were evaluated until 12 months post-treatment. After ITB bolus injection, 32 patients (86.5%) (CP 84.2% versus acquired brain injury 88.9%) showed a positive response of reducing spasticity. However, 8 patients with CP had negative adverse effects. Particularly, 3 ambulatory CP patients showed standing impairment and 1 ambulatory CP patient showed impaired gait pattern such as foot drop because of excessive reduction of lower extremity muscle tone. Ambulatory CP patients received ITB pump implantation less than patients with acquired brain injury after ITB test trials (P = .003 by a chi-squared test). After the pump implantation, spasticity was significantly reduced within 1 month and the effect maintained for 12 months. Seventeen patients or their caregivers (73.9%) were very satisfied, whereas 5 patients (21.7%) suffered from adverse events showed no subjective satisfaction. In conclusion, ITB therapy was effective in reducing spasticity in patients with CP and acquired brain injury. Before ITB pump implantation, it seems necessary to perform the ITB bolus injection to verify beneficial effects and adverse effects especially in ambulatory CP.
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Affiliation(s)
- Young Kwon Yoon
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine Department of Medicine, The Graduate School of Yonsei University Rehabilitation Institute of Neuromuscular Disease Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine Brain Korea 21 PLUS Project for Medical Science, Yonsei University Yonsei Stem Cell Research Center, Avison Biomedical Research Center, Seoul, Korea
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13
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Spasticity Management: The Current State of Transcranial Neuromodulation. PM R 2017; 9:1020-1029. [DOI: 10.1016/j.pmrj.2017.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 03/20/2017] [Accepted: 03/31/2017] [Indexed: 12/18/2022]
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Bilsky GS, Saulino M, O'Dell MW. Does Every Patient Require an Intrathecal Baclofen Trial Before Pump Placement? PM R 2016; 8:802-7. [DOI: 10.1016/j.pmrj.2016.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 11/16/2022]
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15
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Boster AL, Bennett SE, Bilsky GS, Gudesblatt M, Koelbel SF, McManus M, Saulino M. Best Practices for Intrathecal Baclofen Therapy: Screening Test. Neuromodulation 2016; 19:616-22. [PMID: 27434115 DOI: 10.1111/ner.12437] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 02/24/2016] [Accepted: 03/02/2016] [Indexed: 11/29/2022]
Abstract
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. Individuals should not be tested in the presence of active medical issues (e.g., MS exacerbations, active urinary tract infection, nonhealing wounds). Oral antispasmodics can be weaned before trial if a goal is to eliminate them. The standard baclofen test dose is a 50-mcg bolus, 25 mcg in very small children or patients who rely on spasticity for mobility. Patients unresponsive to the standard dose may require 75 mcg or 100 mcg; 24 hours should elapse between bolus doses. Cardiopulmonary parameters should be checked frequently during the first two hours postinjection, and spasticity measures assessed at least twice within four hours. Observation continues until the patient is stable and recovers from hypertonia. Adverse events include spinal headaches, nausea/vomiting, urinary retention, hypotension, seizures, drowsiness/sedation, respiratory depression, and coma. Before implantation, team members must discuss starting dose, drug concentration, delivery mode, pump size and location, and catheter tip placement. Patients/caregivers should understand the commitment necessary for ITB therapy. CONCLUSIONS Screening helps identify appropriate candidates for ITB.
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Affiliation(s)
| | - Susan E Bennett
- State University of New York (SUNY) at Buffalo, Buffalo, NY, USA
| | | | - Mark Gudesblatt
- Brookhaven Memorial Hospital Medical Center, South Shore Neurologic Associates, Islip, NY, USA
| | | | - Maura McManus
- Alfred I DuPont Hospital for Children, The Sidney Kimmel Medical College, Thomas Jefferson University, Wilmington, DE, USA
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