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Intrathecal baclofen pump use for spasticity: a clinical survey
1The Children's Hospital, University of Colorado, Department of Rehabilitation Medicine, Denver 80218, USA.
Objective:
To obtain information from continuous intrathecal baclofen infusion (CIBI) pump centers regarding specific clinical practices and experiences.
Methods:
A total of 115 centers were surveyed by mail.
Results:
Forty centers (35%) responded with information about 1,002 test doses and 936 pump placements. Patient diagnoses included cerebral palsy, spinal cord injury, traumatic brain injury, and others. The average test dose was 50 microg. A total of 87% of trials were successful. The most common test dose complications were nausea/vomiting (2.6%) and sedation (2.2%). Pump placement complications included cerebrospinal fluid (CSF) collection (3.3%), constipation (2.9%), headache (2.4%), and CSF leak (2.2%). The most common long-term complications were catheter kink or migration (4%) and infection (1.2%). Improved daily activities including easier diapering, dressing, transfers, orthotic wear and comfort, and sitting tolerance were reported in the majority (>90%) of patients. Mixed results were reported for oral motor function and head, bladder, and bowel control.
Conclusions:
CIBI is an effective treatment for severe spasticity, with dramatic quality-of-life improvements and a small number of significant complications. Long-term benefits and complications need to be monitored in this complex population.