Special to The Catalyst

A teenage girl in a wheelchair who bravely faced Hurricane Bonnie, a former star athlete just married and now back to riding a bike after a spinal cord injury, and an elderly lady who had spasms so severe they sometimes kicked her shoes off, were recent visitors of MUSC neurosurgeon Brian Cuddy, M.D. and Marc LaPointe, Pharm.D.

They were getting their pumps refilled.

As diverse as they are, each of them has a small pump in the abdomen that automatically delivers a medication called Baclofen to reduce severe spasticity, tightness or stiffness of muscles and enhance overall lifestyle. Their healthy appearance speaks well for the treatment being used, called Intrathecal Baclofen (ITB) Therapy.

MUSC is a key location for installing and maintaining the SynchroMed pump, and claims to be the most important medical center of its kind involved with ITB Therapy in South Carolina, said LaPointe, a clinical pharmacist who works closely with Cuddy and Richard Osenbach, M.D., who coordinate the patients' programming and progress.

“The pump therapy reinforces our concern for quality of patient care and quality of life while relieving pain and suffering,” he said. It is the first medical therapy in decades that eases intractable spasticity in patients with cerebral palsy, traumatic brain injury, spinal cord injury, stroke and multiple sclerosis, according to Medtronic Inc., the developer of the ITB Therapy.

The hurricane “veteran,” Shiloh Littlefield of Myrtle Beach, lives only nine miles from the beach which received Bonnie's onslaught. She resides with her mother, Deborah, and was on hand when the shutters of their home were blown away and other damage was incurred from 75 mph winds. Littlefield, 18, was born with cerebral palsy and had been through many other very violent storms, including tornadoes in Oklahoma.

The bike rider, Harold (Hal) Burrows of Charleston, collided with a car in 1986 while riding a bike “too fast” and survived to once again enjoy bicycling and even swimming. He walks now and no longer has to rely on a wheelchair. Burrows was an athlete at The Citadel and at schools in North Carolina and Virginia. His accident happened in South Carolina where he later recovered. Burrows, 39, travels frequently, including to the Bahamas where he has a direct mail advertising business.

Another Charleston resident, Eleanor Wakley, 73, had such severe leg spasms prior to use of the therapy that she was often embarrassed by the lack of control over her limbs. For example, her spasticity would get so bad that sometimes while sitting in church the spasms would lift her feet and cause her to kick off her shoes, recalls her daughter-in-law, Carol Ferrari. Wakely was diagnosed with multiple sclerosis in her late 50's and had her infusion pump installed several years ago. Previously, spasms also locked her knees in place and cause constant pain. She could barely sit in her wheelchair with the spasms but says now her muscles are relaxed and she feels “immensely better.”

All these patients see Cuddy and LaPointe every two months to get their pumps checked and let the doctor know how well they're getting along.

Refilling their pumps is a 15- to 20-minute in-hospital process, coordinated by LaPointe who assists with follow-up treatment following the doctor's checkup and is especially familiar with the procedures and the drug involved.

The Baclofen is dispensed by the SynchroMed infusion pump implanted by a neurosurgeon slightly under the skin in the abdomen. With the ITB Therapy, the pump delivers the drug directly to the fluid around the spinal cord called the intrathecal space, relaxing muscles with very small dosage, notes Cuddy and Medtronic. There no longer is need to take frequent oral medications.

Specifically meant to treat spasticity of cerebral origin, the drug replaces a natural chemical, which the central nervous system no longer releases. Since the Baclofen goes directly to the site of action, side effects such as weakness, drowsiness and nausea are minimized, notes Medtronic, said to be the World's leading medical technology company specializing in implantable and invasive medical devices. All three patients took many pills previously. Now they no longer need frequent and large doses of oral medication and feel more alert and energetic.

For example, Littlefield notes the Baclofen has made a “tremendously wonderful difference” in her life. Prior to the pump therapy she couldn't drive her powered wheelchair because of spasms. Her arms needed to be strapped down and she had numerous severe cramps through the night when her feet often curled up.

“Her whole life has changed for the better,” says her mom. “Now she can drive her wheelchair by herself, put her feet on the rest pads, and feed herself with her arms.” Since the pump was installed, about three years ago, she has more independent movement, being able to move one arm without moving the other. “Before she had to concentrate so hard to move just one limb,” her mom noted.

Both Littlefield and Burrows have high marks in achievement. Littlefield is upbeat and graduated from high school as a member of the National Honor Society. She'll enter college this December and wants to be a counselor in patient advocacy helping people deal with recovery. “I like helping others,” said Littlefield, who does lots of volunteer work.

She is now quite calm, despite having gone through stormy times in her life with health problems. She has undergone 17 operations relating to her condition since her birth as a premature baby, her mom notes. Besides Hurricane Bonnie, she and her family, including her two sisters, have experienced Hurricane Hugo as well as twisters when they lived in Oklahoma's “Tornado Alley.” She likes to smile and doesn't allow her attitude and emotions to be upset over conditions she can't control.

Although considered somewhat of a rebel in his younger years, Burrows said he is now a great believer in wearing helmets while biking. “It certainly helped save my life…although I resisted them at first,” he notes recalling the collision which left him paralyzed from the neck down in a hospital.

He has made a remarkable recovery, however, and boasts he can do everything now but jog— which he also hopes to do someday. His daily workouts include doing push-ups. He hopes to discard his cane as his walking improves.

Like the others, Burrows claims the pump has been a “terrific boost” in his lifestyle. For about eight years he did not have the pump and was told he would never walk again because of his spasticity. It was installed about three years ago in Richmond and he began walking only about six months following the ITB therapy.

His memories of how fit and energetic he was prior to his accident also helps to motivate Burrows. He recalls the days when he was training for the Olympics. “I really did well in the national competitions in fencing and was a very serious bike racer.” In fact, it was while speeding on his bike in training when his collision happened and his Olympic hopes were dashed.

Now, like the others, he has more to look forward to, especially enjoying his new lifestyle with his bride Debby. Moreover, Littlefield can begin her college life in her desired course of study in the independent style she prefers and Wakely can sit comfortably in church without fear of losing her shoes.