Intrathecal baclofen test dose

This information will explain what will happen when your child come’s into hospital for an intrathecal baclofen test dose.

What will happen when we first arrive at the hospital?

You will need to bring your child to the ward either the day before or early in the morning on the day of the test dose.

A nurse will welcome you on the ward and will complete your child’s admission forms.

On the morning of the test dose, your child will also be seen by the neurosurgeon, an anaesthetist and a physiotherapist.

The neurosurgeon will explain about the test procedure and the anaesthetist will make sure your child is fit for an anaesthetic and will go through what will happen when your child goes to theatre. The physiotherapist will assess your child’s muscle tone and range of movement before they go to theatre.

The physiotherapist will talk to you and your child and together you will make appropriate goals for assessing the effects of the medicine.

What happens during the test dose procedure?

You will be able to go with your child to the operating theatre anaesthetic room, and stay with them until they are fully asleep. The physiotherapist will then assess your child’s joint ranges and muscle length whilst your child is asleep. This helps to see if your child has any further range of movement when their muscles are fully relaxed.

The neurosurgeon will then place a needle at the base of your child’s back and then inject a small amount of baclofen medicine into the space around the spinal cord. The needle will then removed and your child is will be woken up.

What happens straight after the test dose?

Your child will be taken to the recovery room next door to the theatres. The nurse there will call the ward and ask you to come down to see your child as they wake up. Once they are awake they will return back to their bed on the ward.

What happens when my child is back on the ward?

Once they are back on the ward your child can relax and recover from the anaesthetic. The physiotherapist will come to reassess your child’s muscle tone and movements around 4 hours after the baclofen medicine was given. This time allows the baclofen to have its full effect.

How will I know if the baclofen has had an effect?

When the physiotherapist comes to see your child, they will ask you to carry out activities that you have mentioned can be difficult.

This may include: 

• Moving your child’s legs and arms
• Changing clothes
• Nappies or pads
• Transferring your child into and out of their wheelchair
• Putting on splints

And so on.

Your child may be able to tell you how the baclofen has made them feel and how it has affected the control of their movements.

What happens after the test dose?

Your child will stay in hospital overnight after the test dose. The neurosurgeon will review your child in the morning to check that they have made a full recovery. You will then be able to return home.

What if my child is uncomfortable when we go home?

Sometimes after the test dose your child may have a headache. If your child can not tell you where it hurts but does appear irritable and upset, it could be due to a headache. Headaches tend to appear in the first 24 to 48 hours when children sit up. These are called low pressure headaches. We recommend that you gradually increase the time your child spends sitting or standing. If you suspect a headache, give paracetamol for pain relief and lie your child down. If the headache continues even with painkillers and lying down please contact the intrathecal baclofen therapy team.

Do you have to make any decisions after the test dose?

If the test dose has shown a good result, the neurosurgeon and physiotherapist will talk to you about the options. There is no pressure for you and your child to make any decisions at this point. You have time to consider if you need to.