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Continuous intrathecal baclofen infusion for children with cerebral palsy: a pilot study
A Scheinberg1, S O'Flaherty, R Chaseling
1Department of Rehabilitation, The Children's Hospital at Westmead, Westmead, New South Wales, Australia. adams2@chw.edu.au
Insights
Continuous intrathecal baclofen infusion (CIBI) effectively reduced spasticity in children with cerebral palsy. This treatment showed encouraging functional improvements, suggesting CIBI may benefit severely affected patients.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Biomedical Engineering
Background:
- Spastic cerebral palsy (CP) is a condition characterized by increased muscle tone and stiffness.
- Severe spasticity in children with CP can significantly impair motor function and daily activities.
- Current treatments for spasticity in CP have limitations, necessitating exploration of alternative therapies.
Purpose of the Study:
- To evaluate the efficacy of continuous intrathecal baclofen infusion (CIBI) in reducing spasticity in children with CP.
- To assess the impact of CIBI on functional improvements in pediatric patients with severe spasticity.
- To determine the safety and tolerability of CIBI in this population.
Main Methods:
- A prospective study involving two pediatric subjects (aged 8 and 9 years) with severe spastic CP.
- Continuous intrathecal baclofen infusion (CIBI) was administered following a screening procedure.
- Assessments included the Modified Ashworth Scale, Gross Motor Function Measure, and Pediatric Evaluation of Disability Inventory, conducted over a 6-month period.
Main Results:
- Both subjects experienced significant reductions in lower limb spasticity post-CIBI.
- Modified Ashworth Scale scores remained consistently reduced throughout the 6-month study.
- Functional improvements were observed, including enhanced upper limb function, improved mobility, and reduced caregiver assistance.
- Parental reports indicated decreased muscle tone, increased range of motion, and easier daily activities.
Conclusions:
- Continuous intrathecal baclofen infusion (CIBI) is an effective method for reducing spasticity in children with CP.
- The study demonstrated encouraging clinical improvements in function and daily living activities.
- CIBI shows promise as a beneficial treatment for pediatric patients whose spasticity severely impacts function, warranting further investigation.
Objectives:
To determine whether continuous intrathecal baclofen infusion (CIBI) would decrease spasticity and improve function in children with spastic cerebral palsy.
Design:
Prospective study with measurement of changes from baseline assessed at regular intervals for 6 months following the intervention.
Patients:
Two subjects aged 8 and 9 years with cerebral palsy. Inclusion criteria included severe spasticity and age greater than 4 years. STUDY CENTRE: Department of Rehabilitation, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Results:
Both subjects had clinically significant reductions in lower limb spasticity from a single intrathecal dose of baclofen (screening procedure), and had intrathecal pumps implanted. An intensive physical therapy programme was provided for both subjects in the 1-3-month period after commencing CIBI, in order to maximize functional gains. Modified Ashworth Scale scores remained reduced during the 6-month study period. There was a clinically significant increase in upper limb function for Subject 1. Gross Motor Function Measure scores decreased from 22% to 19% for Subject 1, and increased from 6% to 10% for Subject 2 over the study period. Paediatric Evaluation of Disability Inventory scores for Subject 1 showed a reduction in the level of caregiver assistance required, while Subject 2 showed significant improvement in the functional mobility domain. The major changes noted in the parent questionnaires were reduction in tone, increased range of motion and reduced time taken helping with activities of daily living such as toilet and dressing. No significant side-effect was seen after the screening procedure or after continuous intrathecal infusion. Both subjects' parents felt their child was improved following the intervention.
Conclusions:
Children with spastic cerebral palsy can have their spasticity effectively reduced with CIBI. In this study of two children, the clinical improvements were encouraging, and it is proposed that CIBI may be of benefit to those patients whose level of spasticity severely interferes with function. Further studies using multidimensional assessment approaches, with larger numbers of children, are warranted.