Baclofen pump is obstacle for stemcells?

[Shwetarose]

Dr.Young,

I m having baclofen pump implanted. Can pump be obstacle for stemcells? i mean reducing the effect of stemcells? i m saying this bcos one of the patient of Dr.Huang, David Landewee, had baclofen pump and he removed or stopped the drug injecting bcos of stemcell therapy.

Please enlighten.

Thanking you always
Shweta.

<Excerpt>
David Landewee:


I arrived home March 24. My family and some media met me at the airport in Kansas City. Today is April 5. I knew the results from the OEG (olfactory ensheathing glia) cell transplant I received in China would be much more effective after I arrived home.



I have a device implanted in my abdomen called a Baclofen pump. It gives a continuous infusion of Baclofen, a muscle relaxant that, when injected directly into the spinal canal, can alleviate muscle spasms and pain.

I have had bad muscle spasms in the lower part of my body since the injury. I knew that I had to get home and have the pump turned down to be able to notice the real effects of the surgery. The muscle relaxant hinders the strength I am regaining in my abdomen and legs. Since I returned home, I have had it turned down twice, and the spasms have not taken over like they would have before.

This is a positive improvement, which can only be attributed to the cell transplant. There is a list of improvements that have occurred since the surgery: my breathing and lung function is 20 percent better; I can now move muscles in my legs and abdomen that I could not move before; I have started to sweat below the area of my injury; I can move my legs from side to side with no assistance and almost do a sit-up by myself; and my hamstrings, quadriceps, knee flexors, hip flexors, abductors, and inductors are getting stronger daily.

I had my pump turned down halfway on Tuesday and that evening could feel a strange tingling sensation in my toes and was able to move them and flex my ankle a little. I can feel my bowels and internal organs that I could not feel before, and they are working better. I believe that when I am able to turn the pump off completely, my muscle strength and sensation will continue to improve.

The doctors in China told me that the results would continue to improve over 12 to 18 months because it takes time for the axons in the spinal cord to bridge the damaged area and make new connections. I feel as though I got my money's worth from the spinal cord surgery. I am hoping with intensive therapy that within a year I may be able to walk again. It will take a lot of work and therapy.

[John39671]

I had a pump installed in Nov of '05 after a year of procastionating over it. I had it installed at the U of W is Seattle WA. The VA Dr. and the Dr. who did the surgery both reasured me that the pump would not interfear with any recovery, it would just have to be turned down just like in the above mentioned article.

PS; I also wanted to mention in my experence so far these pumps are not all they are cracked up to be. I found out the hard way that if you have a UTI or a preassure sore any where they do not stop your leg spazms. Also if you wheelie off of a curb and loose your balance and fall over backwards the hose that connects the pump to your spine will break and you have to go in for a second surgery to have it repaired. I learned that the hard way.

[teesieme]

You know, I questioned a similar concern yet in a different way- stem cells finding their way through and to- the other day while investigating a possibile route to take for my son in the future~ what of the rods as well as bone stimulator that are still in his back...the answer was they should be be far enough away from the spinal cord to cause problems...Dr. Young?

[Wise Young]

schweta,

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.

Wise.

[Wise Young]

Originally Posted by teesieme

You know, I questioned a similar concern yet in a different way- stem cells finding their way through and to- the other day while investigating a possibile route to take for my son in the future~ what of the rods as well as bone stimulator that are still in his back...the answer was they should be be far enough away from the spinal cord to cause problems...Dr. Young?

teresa,

The fact is that the spinal cord does not regenerate well on its own. Many people do not recover even though they do not have baclofen pumps. It is natural for people to think that something that they are doing is stopping regeneration but there is little evidence that people who are not taking any drugs are recovering more function or doing any better. In general, I believe that people should take as few drugs as possible but people should not allow irrational fears to stop them from taking certain drugs that do help them.

Baclofen is an important drug that has helped reduce complications of spinal cord injury. I still remember the days when there was no way to treat severe spasticity, when doctors had to introduce toxins to kill the spinal cord in people with severe spasticity. Intrathecal baclofen has been a godsend for some people who have severe spasticity that cannot be controlled in any oher way. It also helps with some types of neuropathic pain. It reduces but does not prevent spasms.

Wise.

[Wise Young]

Originally Posted by John39671

I had a pump installed in Nov of '05 after a year of procastionating over it. I had it installed at the U of W is Seattle WA. The VA Dr. and the Dr. who did the surgery both reasured me that the pump would not interfear with any recovery, it would just have to be turned down just like in the above mentioned article.

PS; I also wanted to mention in my experence so far these pumps are not all they are cracked up to be. I found out the hard way that if you have a UTI or a preassure sore any where they do not stop your leg spazms. Also if you wheelie off of a curb and loose your balance and fall over backwards the hose that connects the pump to your spine will break and you have to go in for a second surgery to have it repaired. I learned that the hard way.

John,

You are right that intrathecal baclofen does not prevent leg spasms. I also suggest that the dose of baclofen be adjusted so that it does not make the legs flaccid as well. Spasticity and spasms are the cheapest form of exercise for your legs. The dose should be adjusted so that the there is still some muscle tone. That reduces muscle atrophy.

Wise.

[carbar]

Originally Posted by John39671

I had a pump installed in Nov of '05 after a year of procastionating over it. I had it installed at the U of W is Seattle WA. The VA Dr. and the Dr. who did the surgery both reasured me that the pump would not interfear with any recovery, it would just have to be turned down just like in the above mentioned article.

PS; I also wanted to mention in my experence so far these pumps are not all they are cracked up to be. I found out the hard way that if you have a UTI or a preassure sore any where they do not stop your leg spazms. Also if you wheelie off of a curb and loose your balance and fall over backwards the hose that connects the pump to your spine will break and you have to go in for a second surgery to have it repaired. I learned that the hard way.

Your remarks on the efficiency of the pump are interesting. In what way do you find that the pump is helpful? I have been considered for one but I am not keen. Most of my spasms are in my hip-to-leg area - are you saying that in your experience the pump does not help leg spasms at all? You also refer to an accident damaging the hose to the pump - that was bad luck, but do you find that in general lying on your back, or leaning on your back while in the chair, causes any discomfort or damage to the pump? I was always nervous of having a pump in my back as it about the only place that is impossible to keep a check on for marking etc.
Any further comments from you would be very welcome.

[Wise Young]

Originally Posted by carbar

Your remarks on the efficiency of the pump are interesting. In what way do you find that the pump is helpful? I have been considered for one but I am not keen. Most of my spasms are in my hip-to-leg area - are you saying that in your experience the pump does not help leg spasms at all? You also refer to an accident damaging the hose to the pump - that was bad luck, but do you find that in general lying on your back, or leaning on your back while in the chair, causes any discomfort or damage to the pump? I was always nervous of having a pump in my back as it about the only place that is impossible to keep a check on for marking etc.
Any further comments from you would be very welcome.

Spasticity and spasms have different mechanisms. Baclofen reduces spasticity. It can reduce spasms but only at such high doses that it suppresses all excitability of motoneurons, i.e. producing flaccidity which causes atrophy. The mechanism of baclofen are still not well understood. Several studies have shown that baclofen causes presynaptic inhibition, i.e. reduces the sensory signals that come into the spinal cord (Source), lowering the amount of neurotransmitter released by incoming sensory fibers without reducing the excitability of the motoneurons, at least at low doses (Source).

Let me try to explain further. There are two kinds of motoneurons in the spinal cord: alpha and gamma motoneurons. The former activates the muscles. The latter activates the spindles that sense muscle tension. The spindles are responsible for the so-called stretch reflex, so when the muscle stretches, the spindles send excitatory signals to the alpha motoneurons to fire so that the muscle contracts and reduces the stretch. This is the servo mechanism by which the spinal cord produces specific muscle tension. When gamma motoneurons fire and contract the spindles, this means that only a small stretch will produce greater sensory activation. What baclofen does is to reduce the influence of the sensory information that comes from the spindles. For that reason, at low doses, baclofen does not prevent spasms.

Spasms come from activity of spinal cord interneurons (sometimes called internuncials). The interneurons just fire by themselves, setting off a cascade of activity that often involve multiple muscles and joints. Since a spasm does not involve stretch reflexes or incoming sensory signals, baclofen should not have that much effect on spasms. Note, however, that very high doses of baclofen can suppress all neuronal activity but this produces complete loss of excitability and muscle flaccidity. The latter is not good and leads to muscle atrophy. It is interesting that neurontin (an anti-epileptic drug) does reduce spasms and several people have reported this in the Care Forum. Most doctors don't know this yet but fairly low doses of neurontin is anti-spasmodic.

By the way, here is an article from some old colleagues of mine from NYU Medical Center (I use to work with them) which gives an explanation of spasticity and the different ways of reducing spasticity
http://www.pediatric-orthopedics.com...clofen_oh.html

Wise.

[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?

[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.

John