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Intrathecal baclofen therapy in children with cerebral palsy: efficacy and complications
Nancy A Murphy1, Melanie C Nicole Irwin, Charles Hoff
1Department of Pediatrics, University of Utah, Salt Lake City, UT 84132, USA. Nancy.Murphy@hsc.utah.edu
Insights
Intrathecal baclofen (ITB) therapy effectively reduced spasticity in children with cerebral palsy (CP). However, complications, particularly wound issues, necessitated device removal in a significant portion of patients, highlighting the need for careful patient selection.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Rehabilitation Medicine
Background:
- Spasticity significantly impacts motor function and quality of life in children with cerebral palsy (CP).
- Intrathecal baclofen (ITB) therapy offers a potential treatment for severe spasticity refractory to oral medications.
Purpose of the Study:
- To evaluate the effectiveness of ITB therapy in managing spasticity in young children diagnosed with CP.
- To identify potential risk factors associated with complications arising from ITB therapy in this pediatric population.
Main Methods:
- A consecutive case series involving 25 pediatric patients with CP who received implanted ITB delivery systems over a 48-month period.
- Assessment of spasticity using the Ashworth Scale at baseline, 6 months, and 12 months post-treatment.
- Documentation and analysis of complications, including the reasons for explantation and their association with patient characteristics.
Main Results:
- ITB therapy demonstrated significant reductions in spasticity scores in both lower (P<0.01) and upper extremities (P<0.05) by 6 months, with sustained effects at 12 months.
- Device explantation was required in 44% of cases, primarily due to wound complications (73% of explantations).
- Complications were more frequent in children with mixed-type CP compared to pure spastic types (P<0.01), with trends indicating higher risk in smaller, younger, nonambulatory patients, and those with gastrostomy tubes.
Conclusions:
- Intrathecal baclofen therapy is an effective treatment for reducing spasticity in children with cerebral palsy.
- Complications, particularly wound-related issues, can lead to device explantation, necessitating careful consideration of patient selection criteria.
- Further research is warranted to define optimal criteria for identifying ideal pediatric candidates for ITB therapy to maximize benefits and minimize risks.
Objectives:
To describe the efficacy of intrathecal baclofen (ITB) therapy in the management of spasticity in young children with cerebral palsy (CP) and to identify risk factors for complications.
Design:
Consecutive case series of 25 implanted ITB delivery systems during a 48-month period.
Setting:
Pediatric specialty hospital and outpatient department.
Participants:
Twenty-three children (age range, 4.5-17.4y) with CP (spastic diplegia in 22%; spastic quadriplegia in 61%; mixed-type diplegia in 4%; mixed-type quadriplegia in 13%).
Intervention:
Intrathecal baclofen therapy in children with cerebral palsy.
Main Outcome Measures:
Ashworth Scale scores before treatment and at 6 and 12 months after ITB therapy; frequency and nature of complications; and relation between patient characteristics and outcomes.
Results:
Average Ashworth scores +/- standard deviation decreased from 3.26+/-.73 to 2.34+/-.83 (P
Conclusion:
ITB therapy effectively reduced spasticity in children with CP. However, complications necessitating explantation can occur. Further research is needed to identify criteria describing the ideal pediatric candidate for ITB.
