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Continuous intrathecal baclofen therapy in children with cerebral palsy - when does improvement emerge?
K Ramstad1, R Jahnsen, B Lofterod
1Department of Paediatrics, Oslo University Hospital, Oslo, Norway. kjersti.ramstad@rikshospitalet.no
Insights
Continuous intrathecal baclofen therapy (CITB) shows sequential benefits for children with cerebral palsy. Improvements in pain, sleep, and social function emerge within six months, with mobility benefits appearing later.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Neuroscience
Background:
- Cerebral palsy (CP) presents complex challenges, impacting motor function, pain, and quality of life.
- Continuous intrathecal baclofen therapy (CITB) is a treatment option for severe spasticity in CP.
- Understanding the temporal effects of CITB is crucial for optimizing patient management.
Purpose of the Study:
- To investigate the timing of therapeutic effects of CITB in children with cerebral palsy.
- To analyze changes across various functional domains following the initiation of CITB.
Main Methods:
- A cohort of 35 children with severe CP undergoing CITB were followed for 18 months.
- Key outcomes including pain, sleep disturbances, spasticity, and functional scores (GMFM-66, PEDI) were assessed pre-treatment and at 6 and 18 months post-implantation.
Main Results:
- CITB demonstrated improvements across all International Classification of Functioning, Disability and Health (ICF) dimensions.
- Significant reductions in pain and improved sleep quality were observed within 6 months.
- Social function showed improvement by 6 months, with continued gains up to 18 months; motor function improvements occurred with a delay.
Conclusions:
- The introduction of CITB in children with CP elicits a discernible sequence of functional improvements.
- These findings can inform multidisciplinary teams regarding the optimal timing of interventions during post-operative follow-up for CITB patients.
Aim:
The aim of the study was to explore the timing of effects of intrathecal baclofen therapy in children with cerebral palsy.
Methods:
Thirty five children with severe disabilities with cerebral palsy who started continuous intrathecal baclofen therapy (CITB) were followed for 18 months. Pain, number of awakenings during night, spasticity, GMFM-66 scores and PEDI scores were recorded the day before pump implantation and after 6 and 18 months of treatment respectively.
Results:
Introduction of CITB was associated with changes across all ICF dimensions. Reduced pain and improved sleep occurred within 6 months of treatment. Social function improved within 6 months and continued to improve until 18 months of CITB. Mobility also improved, but with a latency.
Conclusion:
There seems to be a sequence of changes after introduction of continuous intrathecal baclofen in a child with cerebral palsy that may guide the multidisciplinary team in their timing of therapy during post-surgical follow-up.
