The intrathecal baclofen infusion test is used to evaluate the possible effect of the baclofen pump implant. It may be performed prior to the definitive implantation of the intrathecal baclofen pump and, depending on the response, the pump should be implanted or not.This test allows the effect of baclofen administered directly in the cerebrospinal fluid compartment, usually by lumbar puncture or by intrathecal catheter, to be evaluated.The procedure is performed in a surgical center and the patient should be under strict neurological observation. The effects of intrathecal baclofen appear soon after its injection and side effects can occur, such as drowsiness and even difficulty in breathing, so it is necessary to observe the patient in the assisted environment. A common complication following the intrathecal baclofen test is the occurrence of cerebrospinal fluid hypotension, which can lead to severe headache, nape of the neck, vomiting and nausea. To improve these symptoms, the person should be at rest, lying down and with the head low (level below the legs), and well hydrated. For rare cases that do not improve the symptoms in 48h to 72h, it may be necessary to perform blood patch, an infusion of blood into the epidural space by puncture. The risk of experiencing this symptom of CSF is greater when using an intrathecal catheter and when the patient is thin.For patients who do not respond to the initial test with 50mcg of baclofen, a second test with 100mcg of baclofen can be performed for further evaluation. For cases of dystonia or cases of doubtful response, intrathecal catheter delivery and administration by external pump or in daily doses may be necessary for a longer evaluation.The final response of intrathecal baclofen infusion may be different from the test. The test is used to select patients who respond or not to intrathecal baclofen. Once the patient has a response and is beneficial, the patient can undergo a dose-titrated baclofen pump implant until the ideal balance between the infused dose and the motor response is reached, respecting the range of adjustments to minimize effects collaterals. The patient and / or his relative / caregiver should judge whether the improvement obtained with the intrathecal baclofen test justifies the implantation of a definitive pump.Inquire with a functional neurosurgeon when the baclofen test is applicable.
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