“The best two hours of my life at the time.” That’s how Chris Casiez described the dramatic improvements he saw with his spasticity during his screening trial with intrathecal baclofen. A positive response to a test dose of intrathecal baclofen during the screening trial is one of the first steps in determining if an individual is a potential candidate for surgical implantation of a baclofen pump—something Chris desperately wanted to pursue because of severe spasticity that was not responding to therapy or medications.
Approximately one year earlier, Chris had sustained a T8 incomplete spinal cord injury (SCI) as the result of a motor vehicle crash. Chris didn’t see much improvement in his recovery until about 6 months after his injury. However, with the increasing motor function came increased spasticity that worsened over time. Chris’ spasticity got to the point that he couldn’t even straighten his legs without a struggle. His hip and hamstring muscles would contract, forcefully bringing his knees up to his chest and his feet towards his bottom. It was even a struggle to have someone else straighten his legs out for him.
The spasticity made it especially difficult for him to lay in bed and to sleep. There were times when he would sleep in his wheelchair, laying his head on a pillow on a table, because sleeping in a bed was so difficult. He was also in pain from the spasms. “They felt like a constant charley horse.” Obviously, all of this made getting a good night’s sleep virtually impossible.
Chris’ spasticity also affected his ability to transfer properly and to propel his wheelchair. He would get clonus that would cause his feet to slide off his wheelchair footrest. He would also get severe spasms when wheeling up a hill or a curb that would throw him back in his wheelchair. He always had to be sure to have his wheelchair anti-tip bars down or his wheelchair could flip backwards. The spasticity also made it very difficult for him to attempt any kind of walking therapy.
This went on for about a year. During this time Chris tried physical therapy, stretching and ranging his joints, heat and cold packs, as well as using a standing frame in combination with electrical stimulation. The electrical stimulation and standing frame helped a little, but not much and the stretching was very painful. Ultimately, none of the therapies Chris tried were very effective. Chris also tried various oral medications for spasticity, including baclofen, tizanidine (Zanaflex), diazepam (Valium), and gabapentin (Neurontin). He was on this medication regimen for several months, but felt it made no difference. Chris felt the medications made him “very loopy” and the spasms and pain weren’t going away.
It was at this point that a doctor mentioned a baclofen pump as a possible treatment option. A baclofen pump may be an option in those cases of severe spasticity that is not controlled with oral medications or when the patient has medication side effects. Chris had mixed feelings about the idea. He really wanted to do something about his spasticity, but at the same time was skeptical about having something implanted in his body. However, in the end he decided to go for it.
The first step was the screening trial in which doctor’s tested to see if Chris’ spasticity improved with intrathecal baclofen. For Chris the response was dramatic, with a significant decrease in his spasticity symptoms. The next step was the surgery to implant the baclofen pump. After the procedure, Chris was admitted for inpatient rehab. Chris noticed an immediate difference after they put the pump in—“the change was very dramatic.” He was finally able to extend his legs straight and he no longer had pain from his spasms. He was finally able to sleep comfortably.
Chris also gained more movement that had been masked by his muscle tone and spasticity. He was now able to focus on strengthening his legs and over the next couple of months was able to start walking in a walker with leg braces. “The spasms were masking my potential to maximize my recovery.”
In addition to the baclofen pump, Chris also started getting botulinum toxin (Botox) injections in his calf muscles to improve the range of motion in his ankles and to help him flatten out his feet. He gets botox injections every 3 months or so. Without the injections he would stand on the balls of his feet, which would make over-ground walking more difficult.
Chris continues do therapy on his own. He walks at home and goes to the gym where he uses the leg machines, focusing on leg presses, leg extensions, and leg curls. “I work out a lot…5-6 days a week. The working out keeps the spasticity down. The more I work out the better my spasms are. Prior to the pump it was impossible to do that.” Chris also now works part-time. He feels the pump really made a difference and made it possible for him to return to work.
Chris says his spasticity has not completely gone away. He still has high muscle tone in his legs. He feels that this tone helps him stand and helps to reduce muscle atrophy in his legs. However, he’s no longer having difficulty sleeping and has no leg pain from spasms.
Chris has no regrets when it comes to getting the baclofen pump and recommends it to people now who have similar issues. “It’s [the baclofen pump] a godsend.”
Story from Academy of Spinal Cord Injury Professionals