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Thread: Baclofen pump is obstacle for stemcells?

  1. #11
    I only spasm in response to external stimuli e.g., my legs are fine until something bothers them then all hell breaks loose. They respond most violently to heat and cold followed by pain and then postural shifts. Does the comment below explain what is happening?

    ...if a sensory stimulus is followed by a blast of motor activity over a bunch of motor nerves, then that sensory nerve is connected to a nasty internuncial, one that acts alone.

  2. #12
    Senior Member
    Join Date
    Sep 2001
    middle georgia
    i got the pump only 2 month later it scared over dr say i was 1in 1000 to do that so i have to do it again. i hate the part of spams where my legs just stick out and vibrate or kick up and down. the worst is when they go from my toes to my hands that hurts.

  3. #13
    Quote Originally Posted by Steph P
    Dr. Young,

    I have a baclofen pump that is at a high level which has made all of my muscles go flacid. If I were to lower the dose of my baclofen is there any way to get back some muscle tone? Is there anything I can do to regain some tone?
    Yes, Steph, reducing the dose of baclofen should restore tone. In my opinion, the dose is too high. Wise.

  4. #14

    Spasticity results from increased sensitivity of the feedback loop of the stretch receptors. One of the ways in which you test for spasticity is to assess the resistance of the limbs to movement. Spasticity cause the limbs to be stiff. When you stretch the muscles, the alpha motoneurons fire to make the muscles resist the movement. That is spasticity. Another test of spasticity is to have the person lie down with the legs over the edge of a testing table. You straighten out the legs and then let go, timing how low it takes for the legs to drop. In a spastic person, this may take many seconds.

    Spasms result from activity of neurons in the spinal cord. They often involve multiple muscles and even other limbs, as suggested by vjls. Sensory input can elicit spasms, as described by Seneca. Seemingly trivial (but also not so trivial) input can produce spasms. The stimulus does not need to be the specific segment. I have a very good friend who takes care of her son who has high tetraplegia and she comes back sometimes with bruises on her arm, from fending off kicks by his legs when she did something with his upper body. Those neurons are alive and kickin'.


    Quote Originally Posted by john smith
    Thanks Wise for the link. A couple of questions though. Am I correct to understand the difference between spasticity and spasms is: spasticity=clonus/tone but spasms=extraordinary extension and flexion? And is that the same understanding that your colleagues from NYU are operating under in their paper? Is SDR an option in the presence of spasms or only spasticity?

    This is the most clearly explained study of spasms/spasticity I have seen in the three years since Noah's accident. His spasms are disrupting his life and leading to considerable muscular pain. He has chosen to live free of anti-spasmodics (in fact all medication other than ditropan) because they had proven ineffective and inhibitory to his voluntary movement AND mental functioning.

    Baclofen pumps are invasive and, anecdotally, come complete with yet another set of complications related to the mechanics. Furthermore, our very unscientific understanding of the terminology makes us wonder if a pump would even apply to his symptom, assuming baclofen is best in the presence of spasticity not spasms.


  5. #15
    Senior Member patd's Avatar
    Join Date
    Aug 2003
    Boise, Idaho, USA

    Baclofen Pump

    I've had a baclofen pump in for 2 of my almost 3 yrs of SCI. We started low then worked up to a high level (~800mic/day). I was comfortable. As return started I always wondered if there was any effect. Since last Spring I have been slowly turning the dose down. Throughout this whole time I have been working really hard physically. I have some increased tone but not as much as I thought I would. Each time I turn the pump down I have felt more feelings in my legs. This is consistent with what I read above in Dr. Youngs post.

    I'm now at 500 mics/day and planning to go lower. I am continuing to enjoy more feelings in my legs and my torso/hips are really filling in with muscle movement. I do have neurological pain at the base of my spine and buzzing/excited feelings in my feet. These feelings in my feet, I believe used to be masked by the baclofen. I'm less comfortable now. It takes about 2 weeks before I get used to the feelings and get good sleep. I find I can do fine during the day with these feelings.

    After sitting up on a Schwinn Airdyne and pedalling and walking suspended above an elliptical trainer my legs are filling in with Feeling, muscle and they get really tired, but I can't Move them by myself(much). I workout hard before or after work so that sleeping is easier. My thinking is that your baclofen setting could help knock down feelings/spacticity that keeps you from sleeping.

    I'll still get leg spasms while doing different things, but they go down quickly. I don't think they are bad. I can lift my leg/foot up when my left leg is spasming. So, I'll push on turning the pump down and monitor my sleep, feelings and movements. Pat

  6. #16
    Quote Originally Posted by Wise Young

    The baclofen is not an obstacle for stem cells. It is an anti-spasticity drug that reduces the excitability of the spinal cord, both abnormal excitability as well as voluntary control of the spinal cord. David Landewee described how his doctors reduced the dose of baclofen so that he could exert more voluntary activity.

    I don't think that there is any convincing evidence that baclofen reduces recovery or regeneration. This has been suggested by some people but I have not been able to find any credible evidence that support this suggestion. Baclofen is a GABA-B agonist. GABA is an inhibitory receptor. It effects two receptors on neurons, GABA-A and GABA-B. GABA-A is a neurotransmitter gated chloride channel which causes hyperpolarization of neurons, counteracting the depolarizing effects of excitatory neurotransmitters. GABA-B receptors act through intracellular messengers and probably reduce the excitability of neurons indirectly through suppressing genes that increase excitability of neurons. While reducing neuronal excitability may, in theory, may reduce ability of neurons to regenerate, I am not sure that GABA-B receptor stimulation reduces axonal growth or that stem cells express GABA-B receptors.

    Thank u doctor a millions i was really tensed.

  7. #17
    Dr Young - thank you for all this information on spasticity, spasms and baclofen. I find it really helpful.
    None of the doctors that I have seen ever made a distinction between spasticity and spasms in the way that you have. I have spasms and was prescribed oral baclofen (lioresal) in increasing doses but I didn't find it to be doing anything so I gradually came off it. Since then each doctor I have seen about my spasms has suggested the pump, but I am reluctant. Now, given the simple tests you mention for spasticity I don't think that I suffer from significant spasticity, just from individual spasms. One habitual leg spasm has stiffened a muscle at the back of the knee, but I work on that to loosen it.
    What I am saying is that from what you say I may indeed not be aided at all by a baclofen pump (despite my doctors promoting it as such), but better by continual exercise.

  8. #18
    Junior Member
    Join Date
    Jan 2005
    Liberty, MO. 64068

    Baclofen Pump

    I would not have a baclofen pump implanted unless absolutely necessary. I agree with Dr. Young that spasms can be a good thing to keep muscles from atrophy but you need to do stretching as well to keep from getting drop foot or ending up in a fetal position. My spasms were controlled with oral baclofen before the pump was implanted. The doctor told me that it would help with the neuropathic pain so I let them put it in. It did absolutely nothing for the pain but did control the spasms well. I believe the bad part about the pump is your body becomes dependent on it. I have tried to wean off of it several times with no success and the spasms came back much worse than before. This is the first time I have been able to turn it down this low without bad side effects. I am currently at 75 ug's per day, I started at 600. Also, if you are out of the country or a place that does not service the pump and it malfunctions you can be in real trouble. They did not install or have a programmer in China so if I would have had any problems it would have been agonizing. I also had one replaced because the battery was going down and the new one was bad. It took them two weeks to figure it out and I looked like a Rockette. It was the worst two weeks I ever had. I was taken to the hospital in an ambulance, got dehydrated, and for a while did not know if I would make it. I will be happy to have mine removed, hopefully later this summer if things keep improving. If you can live without it, I believe you are better off. If your spasms are so bad that they effect your daily life and may cause you to have accidents, then you may consider it. One drug you might consider that has some pain and spasticity relief is Elavil. I take one at night to help me sleep and it seems to calm down the spasms and helps with neuropathic pain. I hope this helps,
    David Landewee
    Last edited by JDLandewee; 01-24-2006 at 06:17 PM.

  9. #19
    Junior Member
    Join Date
    Sep 2006
    seattle, wa

    Baclofen dosage levels

    Quote Originally Posted by Steph P
    Dr. Young,

    I have a baclofen pump that is at a high level which has made all of my muscles go flacid. If I were to lower the dose of my baclofen is there any way to get back some muscle tone? Is there anything I can do to regain some tone?
    Steph P: (I think) I am a new CC member & happened across your letter of 01-06. I would be interested in hearing what you were told in response to your questions. My Baclofen pump dosage levels are similar. Thanks.

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