What is a baclofen pump… Prof. Krasimir Minkin in front of FACT

The first baclofen pump in Bulgaria for the treatment of severe spasticity was implanted in the Neurosurgery Clinic of the University Hospital “St. Ivan Rilski” – Sofia. This is a modern device that is placed under the skin in the waist area and delivers the drug directly into the spinal canal through a thin catheter. This achieves a strong effect with a smaller dose and minimal side effects. The pump is programmed via a tablet – just by touching the skin. Prof. Dr. Krasimir Minkin, a specialist neurosurgeon at the University Hospital “St. Ivan Rilski” – spoke to FACT on the topic.

- Prof. Minkin, at the University Hospital “St. Ivan Rilski" you implanted a baclofen pump. What is the device? Tell me more?
- The baclofen pump is a device that can reduce spasticity (pathologically increased muscle tone) in patients with brain or spinal cord injury. This device resembles a disk with a diameter of 9 cm and a thickness of 2 cm, which is implanted under the skin of the abdomen and delivers the drug Baclofen around the spinal cord through a catheter with a diameter of about 1 mm. In this way, a high dose of the drug is achieved around the spinal cord at a low dose around the brain. This allows for great effectiveness of the drug and fewer side effects at a hundred times lower doses compared to taking Baclofen by mouth.

- In which patients can it be inserted and how is it decided whether it is an appropriate treatment?
- Such patients may suffer from multiple sclerosis, spinal cord injury, transverse myelitis, severe cerebral palsy, hereditary paraparesis. The baclofen pump does not provide additional muscle strength and it cannot be expected that patients will walk, but their suffering due to pain or abnormal position can be significantly reduced.

A baclofen test is mandatory for each patient,

which is a lumbar puncture and injection of a single dose of Baclofen to assess whether the effect of the treatment would be satisfactory. If the baclofen test is positive, the patient is presented to a specialized committee, which makes a decision.

- At what stage of the disease can the baclofen pump be placed in the patient?
- Treatment with a baclofen pump is used in severe spinal cord injuries and in advanced forms of multiple sclerosis, transverse myelitis, cerebral palsy, hereditary paraparesis. Typically, patients who need a baclofen pump have lost their ability to walk.

- Is the procedure covered by the National Health Insurance Fund?
- Fortunately, the intervention and the implant are fully covered by the National Health Insurance Fund and patients do not pay anything related to the implantation.

- Is the intervention difficult to place?
- No, the operation is not distinguished by surgical complexity. The intervention resembles a lumbar puncture followed by implantation of the disk with the pump in the subcutaneous tissue of the abdominal wall. The procedure usually lasts less than 1 hour.

- The first patient is a 48-year-old woman with multiple sclerosis. How did you choose her?
- This is the second patient who was referred to us, and the first in whom the baclofen test was positive. Her spasticity decreased significantly after a Baclofen injection during a lumbar puncture, which led us to suggest the placement of a permanent Baclofen pump.

- How many places in Bulgaria are baclofen pump implants performed?
- For now, baclofen pumps are implanted only in our hospital - UMBAL “St. Ivan Rilski. This is the only center for Functional Neurosurgery in the country, and we have the mission and moral obligation to introduce all established surgical methods to improve the functioning of the nervous system. The Center for Functional Neurosurgery of UMBAL “St. Ivan Rilski“ helps patients with drug-resistant epilepsy, Parkinson's disease, dystonia, pain, and now spasticity.

- How widespread is this method worldwide and what is the monitoring of its effectiveness?
- The idea of baclofen pumps arose 40 years ago and every year in the USA alone, over 10,000 baclofen pumps are implanted. The effectiveness of the method on spasticity is significant in patients with a positive baclofen test. The advantage of these pumps is that it is possible to adjust the dose to obtain maximum effect with minimal side effects. The dose can also be adjusted within the day and be higher during hours with more spasms and lower when the patient has less need.