ITB Pump – Trial Dose Before Implantation — SCE Neurology MCQ

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ModerateNeurorehabilitationITB Pump – Trial Dose Before ImplantationSCE Neurology

A 50-year-old man with longstanding MS has severe bilateral leg spasticity despite maximum oral antispasmodics. He is wheelchair-bound (EDSS 8.0). His rehabilitation team discusses intrathecal baclofen (ITB). Before pump implantation, what test is performed?

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Correct answer: E — Intrathecal baclofen trial (test dose via lumbar puncture)

Before intrathecal baclofen pump implantation, a test dose of intrathecal baclofen is administered via lumbar puncture to assess the patient's response. A positive response (significant reduction in spasticity measured by the Ashworth Scale over 4–8 hours) confirms that the patient will benefit from a permanent pump. The trial also allows assessment of potential side effects (sedation, respiratory depression, hypotension). A: MRI may be needed for pump planning but is not the test of response. C: EMG is not relevant to spasticity assessment. D: Urodynamics assess bladder, not spasticity. E: BP monitoring is part of safety but not the primary test.

Reference: NICE NG100 MS (2022); ABN Spasticity Guidelines