On Friday 29 mei 2020, E.M. Delhaas will defend his PhD dissertation, entitled: ‘Intrathecal Baclofen Administration in Severe Spasticity’.
Spasticity is the result of brain or spinal cord damage. For drug therapy, usually, oral baclofen is used. However, due to the blood-brain barrier, a small amount reached the site of action. When baclofen, with a small catheter and an implanted pump, is administered in the fluid space around the spinal cord (intrathecal administration), much more effective result with fewer side-effects can be achieved. The treatment method is used in severe spasticity. In the event of failure of the therapy, there is a need for extended diagnostic procedures to exclude a drug delivery failure before deciding on exacerbation of the disorder or tolerance for the treatment. In clinic practice, diagnostic procedures seem to be too few, too limited or performed too late. These observations indicated a need for improved failure treatment, which motivated this thesis. In summary, all X-rays of the implanted drug delivery device were examined, and as a result, a checklist of a correct interpretation was developed. On the base of the missing visibility of part of the drug delivery system on X-ray, a method was developed with low radiation dose CT with 2D/3D reconstructions to visualize the whole system. Furthermore, 70 contrast CT- and 36 isotope procedures of evaluation of the intrathecal drug delivery were examined and improvements were discussed. In the event treatment failure was caused by obstruction of the spinal cord fluid flow, with the restoration of this flow, clinical effect could be achieved again. Finally, the emergency treatment of an uncommon complication was discussed.
The PhD defences will not take place publicly in the Senate Hall or Professor Andries Queridoroom due to the coronavirus. The candidates will defend their thesis online.