Intrathecal Drug Pumps: A Solution for MS Patients

Multiple sclerosis affects approximately one million people in the U.S., with a range of indicators of severe impairment. It is the predominant neurological disorder among young adults. Spasticity, painful stiffness and muscle spasms, is one common symptom. At UI Health, this month serves as an opportunity to showcase its extensive approach to MS care.

UI Health stands alone in offering intrathecal drug pumps as the solution to manage spasticity and chronic pain. Through its staff of professionals dedicated to one-on-one care, UI Health provides patients with the newest and most effective available options to restore mobility and reduce pain.

But in order to best benefit from these treatments, one must be aware of how MS affects the body.

Understanding MS

MS is a chronic disease that attacks the central nervous system by destroying the insulation of nerve fibers, which is called myelin. This disruption in communication between the brain and the rest of the body causes a variety of symptoms depending on the site and the extent of the damage to the nerves. Symptoms usually consist of chronic pain, immobility, memory loss, mood swings, numbness, loss of vision, and weakness.

While the exact cause of MS is unknown, it is considered an autoimmune disorder since the body’s immune system mistakenly attacks the myelin sheath. Over time, the continued attack can result in potentially long-term disability.

Types of MS—primary-progressive, secondary-progressive, relapsing-remitting, and progressive-relapsing—are determined by their progression and the frequency of relapses.

Because MS is not yet curable, UI Health offers a range of advanced treatments to allow patients to manage the disease, recover from flare-ups, and reverse the consequences of the disease. From medicine-manipulating therapies and physical therapy to cutting-edge solutions like intrathecal drug pumps, UI Health offers comprehensive care for every MS patient’s specific requirements.

Intrathecal Drug Pumps

“It is rare for symptoms to just go away for patients with multiple sclerosis,” said Dr. Konstantin Slavin, a neurosurgeon and professor at the University of Illinois Chicago (UIC). In cases where spasticity becomes severe and unmanageable with medication alone, surgical intervention, such as intrathecal drug pumps, could be the most effective option.

Intrathecal space refers to the area between the covering membranes and spinal cord filled with fluid. The catheter and pump are the components of the device, and both are inserted via surgery so that medication can reach the spinal cord and nerves directly. They insert one incision in the abdomen to insert the pump and a second incision in the back to place the catheter into the spine. The catheter is tunneled down to the abdomen, where it is connected to the pump. Like clockwork, the pump is electronically programmed remotely to administer measured amounts of drugs at programmed times into the spine.

By infusing medication directly into this space, the pump offers targeted relief. Additionally, because the medication is delivered exactly where it’s needed, intrathecal pumps require significantly lower microgram doses when compared to milligrams provided by pills. This targeted approach not only enhances effectiveness but also minimizes the side effects commonly associated with pill use.

“When medication is taken orally,” Dr. Slavin said, “it has to travel through the body, and only a small amount can reach the spinal cord. If we inject it into the spinal fluid, it goes directly where it is needed to treat the patient.”

Patients return for refills every three to six months—a straightforward outpatient procedure. The pump’s internal battery sustains function for approximately seven years. The pump also archives the patient’s treatment information and dosages into its memory so doctors can access the details.

What to Know

Though the surgical process and procedure are kept at a minimum and relatively short, the UI Health staff prioritizes patient education by educating patients and explaining the potential dangers in depth. The patients are asked to observe carefully following the implantation for their body to adjust to the medicine so the proper dosage is administered, as well as the most beneficial time to perform the treatment to be released into the system and pumped from the pump.

“The risks mostly have to do with not getting enough medication or too much. If there is too much, the medication may have side effects leading to weakness and fatigue. If it is not enough, it is not properly treating the muscle pain,” said Dr. Slavin.

Depending on the patient’s condition, adjustments to the infusion rates can be made, including alterations to dosage and time setting. These modifications are guided by patient feedback, symptom monitoring, and regular clinical assessments for optimal pain relief. If side effects occur, the infusion can be paused or recalibrated to prevent complications while maintaining treatment.

“It’s also testable,” Dr. Slavin stated. “Before we implant the pump, we can test patients through a spinal tap, which is an injection into their spinal fluid, to see how they respond to the treatment. For many other surgeries, we cannot test the treatment beforehand.”

Treatment Options

As a center of excellence in MS care, patients can take advantage of the most up-to-date treatments. UI Health is committed to managing symptoms and slowing disease progression with a team-based approach that unites the collective skills of surgeons, neurologists, anesthesiologists, and pain specialists to offer innovative solutions. This multi-disciplinary treatment ensures all facets of a patient’s condition are comprehensively evaluated and treated, leading to better, long-term symptom control.

The first surgical pump placement conducted here was over 25 years ago,” Dr. Slavin stated. “UI Health has only honed its skills and expertise since then. This practice manages well over 200 pumps for patients with multiple sclerosis from all over the world.”

For more questions and information on treatment options, please visit: Neurology and Neurosurgery or call 312.355.0510.