STORY BYAn estimated 160,000 Americans suffer stokes each year, making it the third leading cause of death in the United States. Another 330,000 will live but experience painful, spastic muscles as a result of this "brain attack."
Neurologists at The University of Texas Medical School at Houston are currently testing a surgically inserted pump that may help alleviate this muscle rigidity. The device, called an "intrathecal baclofen pump," dispenses an anti-spasmodic drug, baclofen, directly into the spinal cord area.
Baclofen has been used for years as an oral medication for muscle spasticity, but it needed to be given in very large dosages and often caused both physical and mental fatigue. It also affected the healthy muscles as well as the impaired muscles.
"We can give much smaller doses of the baclofen so it doesn't have the side effects of the oral medicine," says Mya Schiess, M.D., associate professor of neurology and principal investigator of the study. "The pump is really underappreciated. We hope to show that patients experience a loosening of their muscles and a reduction in pain while also experiencing few, if any, side effects."
"The pump is a much more accurate and, for the patient, tolerable way of administering the drug," says Stan Fisher, M.D., an investigator in the study and chief neurology resident at the UT Medical School. "Baclofen enables the muscles to loosen, allowing patients to participate in physical therapy and alleviating the literally crippling pain of the spasms."
Neurology Fellow Dr. Robert Izor holds a Baclofen pump up next to the incision where patient David Jones had his pump inserted less than two months ago. Jones, who had a stroke three years ago at the age of 32, has reported improved mobility and less rigidity in his muscles since the pump was surgically implanted. He anticipates returning to his pre-stroke hobbies of scuba diving and horseback riding soon.
Photo by: Shannon Rasp
Patients are treated with the drug before the pump is inserted to determine if they respond to it. If they do, the pump is then surgically implanted in the waist area of people who have had strokes and are experiencing spasticity in their muscles as a result. The pump contains a catheter which releases the baclofen into the spinal fluid at the fourth thoracic disk in the upper back. This corresponds to chest-level in the front of the body. The baclofen then acts as a muscle relaxant. The procedure takes about 45 minutes.
"Placing the catheter at the chest level is fairly unusual. We do it this way because it gives us more effect on the upper extremities," Schiess says. "Most surgeons place the catheter in the lumbar region [lower back] and it mostly affects just the legs."
The pump itself is made from titanium and is about three inches in circumference. A computer makes adjustments in the medication dosage released into the body - no surgery is necessary for adjustments. About every three months, the patients must have the pump refilled, a simple procedure that is done in the doctor's office.
For stroke patients Glenn Gann and David Jones, who are both participating in the study, the spasticity was so severe that neither was able to work or participate in activities they had previously enjoyed.
"I had a hard time even walking, let alone doing anything else," says Gann, 53, who had a stroke three years ago. "I felt like I had a charley horse in my left leg all the time, and my lower back and hip muscles would tighten up and cause a lot of pain. But that's eased up since they put the pump in me. My muscles are looser, and I'm getting more movement."
Jones, 35, also suffered a stroke three years ago and had debilitating weakness on his left side. Once doctors implanted the pump, he was able to go back to work within a few weeks. Now he looks forward to someday soon being able to ride horses and SCUBA dive again.
Doctors are encouraged by the results they've seen so far, and are closely following the progress their pump patients are making.
"It gives people a second chance at rehabilitation, which might have been hindered because of too much tone," says Dr. Robert Izor, a neurology fellow who is monitoring patients in the study. "We believe this pump can help stroke patients return to the active lives they knew before their stroke."
UPDATED: 1-15-2004
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Dr. Mya Schiess is an associate professor of neurology for the UT Medical School.
See Dr. Schiess also at:
Dr. Stan Fisher is the chief neurology resident at the UT Medical School.
See Dr. Fisher also at:
Summer Carbon Monoxide Dangers
Generators used to cool off homes in hot summer months can cause death through carbon monoxide (CO) poisoning.
CO is an odorless, colorless gas that can kill or seriously and permanently injure people who inadvertently breathe in the noxious fumes emitted from generators in an enclosed space.
During hurricane season, emergency rooms see a rise in cases of CO poisoning from people bringing generators into their homes to provide power, often for cooling fans as well as cooking.
“During Hurricane Rita, we had a family of five die here in Houston for CO poisoning,” reminds UT Medical School Hyperbaric Medicine expert, Dr.Caroline Fife. “The Center for Disease Control and Prevention tracked deaths from CO poisoning due to combustion engines after Katrina and Rita and there was a dramatic increase.”
“Teak surfing”—holding on to the back of a power boat’s swim platform and being towed—is another danger. The boat’s exhaust pipe is in the face of the swimmer.
People riding in the back of pick-up trucks are at risk, too. Numerous cases have been cited of children poisoned by riding beneath tarpaulins or enclosed “cabs” in the back of the truck. In these cases, the trucks had a leak in the exhaust system or a rear-exiting tail pipe, not a side exit.
Fife also has seen this in boats with malfunctioning exhaust systems. She urges doctors and bystanders to pay special attention when groups of people begin to feel ill at the same time, particularly severe headache and nausea. Children often become symptomatic before adults.
“People associate CO poisoning with cold weather and northern states, but in the South, we see it a lot in summer with people just trying to stay cool,” Fife says.
