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Spasticity in a child with myelomeningocele treated with continuous intrathecal baclofen
A Tommy Bergenheim1, Margareta Wendelius, Saeed Shahidi
1Department of Neurosurgery, University Hospital, Umeå, Sweden. tommy.bergenheim@neuro.umu.se
Insights
Intrathecal baclofen infusion effectively managed severe spasticity and pain in a myelomeningocele patient unresponsive to surgery. This treatment offers a viable option for similar challenging cases.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Surgery
Background:
- Myelomeningocele frequently causes severe spasticity and pain, significantly impacting quality of life.
- Surgical interventions for underlying pathologies like hydromyelia and tethered cord can fail, leaving limited therapeutic options.
- Managing refractory spasticity in pediatric patients presents a significant clinical challenge.
Observation:
- A 7-year-old boy with myelomeningocele experienced severe lower limb spasticity and pain.
- Previous surgical treatments, including untethering and posterior fossa decompression, provided no symptom relief.
- Intrathecal baclofen administration resulted in complete alleviation of spasticity and pain.
Findings:
- A trial of 25 microg of intrathecal baclofen provided total relief from spasticity and pain.
- Continuous intrathecal baclofen delivery via an implanted pump maintained excellent spasticity control over 32 months.
- Daily baclofen dosage ranged from 55-157 microg, demonstrating effective long-term management.
Implications:
- Intrathecal baclofen pump implantation is a potential surgical solution for severe spasticity in myelomeningocele patients.
- This approach offers a valuable therapeutic avenue when conventional treatments fail.
- Further consideration of continuous intrathecal baclofen delivery is warranted for refractory spasticity in this population.
Abstract:
Patients with myelomeningocele may often suffer from severe spasticity. Surgical treatment of the underlying pathology such as hydromyelia and tethered cord may be successful, but failures are not uncommon. Those cases may offer a surgical challenge since further therapeutic options are limited. We present the case of a 7-year-old boy with myelomeningocele and related conditions suffering from severe spasticity and pain in his lower limbs. Surgical efforts with untethering and posterior fossa decompression failed to improve the symptoms. A test with 25 microg intrathecally delivered baclofen showed a total relief of spasticity and pain so that a pump for continuous baclofen delivery was implanted. During 32 months of follow-up, his spasticity has been under excellent control on 55-157 microg baclofen per day. Continuous delivery of intrathecal baclofen may be a surgical option to consider in patients with myelomeningocele and severe spasticity.
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