Neuromodulation : journal of the International Neuromodulation Society
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Two patients previously implanted with intrathecal Baclofen (ITB) pumps for management of intractable spasticity due to multiple sclerosis (MS) were referred to our center for ongoing management of their spasticity. Initial evaluation of these patients revealed high levels of spasticity in the presence of ITB doses 10 times the average daily dose of our other MS patients. ⋯ These cases illustrate the need for early ITB pump troubleshooting to identify catheter problems, improve efficacy, and avoid unnecessary healthcare costs.
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In intrathecal drug delivery, visualization of the device has been performed with plain radiography. However, the visibility of the related structures can be problematic. In troubleshooting, after the contrast material injection via the catheter access port, a computed tomography (CT) scan has been used. In troubleshooting, we also used a non-contrast CT scan with 2D and 3D reconstructions. With the current phantom study, we aimed to obtain high-resolution imaging of a poor opaque catheter with the use of a low-dose single-energy 2D and 3D CT scan with limited radiation exposure as a substitute for plain radiography. ⋯ Dr. Delhaas reports personal fees from Medtronic Inc., as a previous consultant, outside the submitted work; Prof. van der Lugt reports grants from GE Healthcare, Siemens, Stryker, Medtronic, and Penumbra outside the submitted work.
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The approach to intrathecal (IT) drug delivery malfunction is complicated, particularly for iodine-allergic patients. In these situations, the current literature has not addressed the use of IT gadolinium. Case reports exist showing severe neurotoxic manifestations with IT gadolinium use. We sought to provide a resource for chronic pain physicians treating an iodine-allergic patient and considering the use of IT gadolinium. ⋯ Herein, we provide guidance on IT gadolinium usage and a framework for IT pump malfunction in iodine allergic patients.
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Structural differences of implantable drug delivery systems (IDDSs) might have an impact on the efficiency of needle access to the reservoir fill port (RFP). The aim of this study was to assess the efficiency of RFP needle access with an ultrasound (US)-guided vs. a blind refill technique in IDDSs with a Recessed RFP (Recessed-RFP-IDDS). ⋯ The results of this study suggest that there is no difference in the RFP needle access efficiency between the US-guided and the blind refill technique in superficially located Recessed-RFP-IDDSs, if performed by experienced practitioners. However, the study did not address efficiency of the RFP needle access in IDDSs with aberrancy in pump location or refills performed by inexperienced staff.
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There are an ever-increasing number of patients who have implanted devices for targeted delivery of drug therapy to the intrathecal space for the management of spasticity or chronic pain. This leads to a growing number of people with implanted pumps presenting for procedures and surgeries, yet there is a paucity of consolidated information available to describe the appropriate precautions and patient management during this period. ⋯ Our article outlined perioperative considerations when dealing with a patient with intrathecal pump undergoing surgical or imaging modality.