Psychosocial and medical factors associated with intrathecal baclofen pump explants: A case series

Issue title: Cerebral Palsy

Guest editors: Rachel Byrne, Deborah Gaebler-Spira, Michael Green and Heakyung Kim

Article type: Case Report

Authors: Reyes, Fabiola I.^{a; d; *} | Herge, Whitney M.^b | Cerza, Shelby L.^b | Savedra, Allen^c | Thompson, Catherine E.^c

Affiliations: [a] Department of Neurology and Rehabilitation Medicine, Scottish Rite for Children, Dallas, TX, USA | [b] Department of Psychology, Scottish Rite for Children, Dallas, TX, USA | [c] Department of Research, Scottish Rite for Children, Dallas, TX, USA | [d] Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA

Correspondence: [*] Corresponding author: Fabiola I. Reyes, MD, Scottish Rite for Children, 2222 Welborn Street, Dallas, TX 75219, USA. Tel.: +1 214 559 7831; E-mail: [email protected].

Abstract: PURPOSE:The goal of this retrospective chart review study was to explore factors that contributed to consideration of or actual pump explantation in pediatric patients with intrathecal baclofen (ITB) pumps. METHODS:Medical records of 30 patients with ITB pumps were reviewed. Quantitative data, including demographic, clinical, psychosocial, and service utilization variables were culled from the records. Qualitative data were collected from clinic visit notes, pump-related follow-up phone calls, and any pump-related emergency room visits. RESULTS:Of those reviewed, six underwent ITB pump explantation, and two considered explantation. Factors contributing to pump explantation or consideration of explantation included the following: postoperative infection, pump malfunction, non-adherence, anxiety/behavioral factors impacting the patient’s tolerance of the pump, distance to the medical provider, frequency of required pump refill appointments, lack or perceived lack of intrathecal baclofen effect, and difficulty transitioning to adult care providers. CONCLUSION:Due to the complex care regimen associated with ITB pumps and various psychosocial and logistical factors that impact treatment success, a standardized multidisciplinary pre-implantation education, screening, and assessment process should be developed. Such a process would ensure that patients/families receive appropriate education, including proactively identifying treatment barriers and potential complications, possibly minimizing dissatisfaction with treatment and the need for explantation.

Keywords: Pediatric, psychosocial needs assessment, baclofen, intrathecal baclofen pump

DOI: 10.3233/PRM-210097

Journal: Journal of Pediatric Rehabilitation Medicine, vol. 16, no. 1, pp. 99-108, 2023