Intrathecal baclofen in cerebral palsy: A decade of treatment outcomes

Continuous intrathecal baclofen (CITB) is considered a standard treatment for spasticity in patients with cerebral palsy (CP). This review summarizes the recent literature and assesses the evidence for the efficacy of ITB for spasticity and its related sequelae in patients with CP. The literature was searched using electronic databases and reference lists from March 2000 through April 2007. Studies included report treatment effects of ITB in patients with CP. The outcomes reported in the 29 studies identified are classified using the International Classification of Functioning, Disability and Health model. The studies are graded for their level and, when appropriate, quality of evidence. The majority of the studies are case series which receive a Level IV grade of evidence. One study provides Level II evidence for the reduction of spasticity after administration of a bolus test dose of ITB as documented by changes in neurophysiologic reflexes. Longer term studies support the effectiveness of CITB for maintenance of muscle tone reduction as documented by clinical scales. Multiple studies suggest a linkage of CITB with improvements in function, ease of care, and quality of life. The evidence for improvements in dystonia and musculoskeletal problems is equivocal. Limitations of the research in this area and recommendations for improving its quality are discussed.