Intrathecal baclofen pump: a foreign-body reaction case report and its solution

Area of Science:

• Neurology
• Dermatology
• Biomaterials Science

Background:

• Intrathecal baclofen pump (ITB) therapy is effective for managing severe spasticity in conditions like cerebral palsy.
• Complications, though rare, can impact treatment efficacy and patient quality of life.

Observation:

• A patient with cerebral palsy experienced recurrent aseptic skin reactions and partial pump exposure following multiple intrathecal baclofen pump implantations.
• Despite negative skin patch tests and absence of infection signs, symptoms resolved upon pump removal and recurred upon reimplantation.
• Histological examination revealed a foreign-body reaction without signs of contact dermatitis or infection.

Findings:

• A foreign-body reaction to the intrathecal baclofen pump, presenting as skin intolerance, was diagnosed.
• The patient's symptoms resolved completely after reimplantation with a pump coated in polyethylene terephthalate.
• A 3-year follow-up confirmed no recurrence, with improved patient outcomes.

Implications:

• Foreign-body reactions to intrathecal baclofen pumps are a previously unreported complication, even with negative dermatological assessments.
• Suspecting skin intolerance in cases of unexplained local reactions is crucial for timely diagnosis and management.
• Utilizing pumps with inert coatings, such as polyethylene terephthalate, presents a viable and effective solution for patients experiencing such intolerance.