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Positive experience with intrathecal baclofen treatment in children with severe cerebral palsy
Tinett Martesen Overgård1, Lars Kjærsgaard-Hansen, Morten Søe
1Psykiatrisk Afdeling, Odense Universitetshospital, Kløvervænget 25, 5000 Odense C, Denmark. tinett.overgard@rsyd.dk.
Insights
Intrathecal baclofen (ITB) effectively reduced spasticity and dystonia in children. Parents reported high satisfaction and recommended ITB, indicating its safety and efficacy for pediatric patients.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Rehabilitation Medicine
Background:
- Intrathecal baclofen (ITB) is an established treatment for severe spasticity and dystonia in children.
- The Region of Southern Denmark has utilized ITB since 2003.
Purpose of the Study:
- To retrospectively analyze the efficacy of ITB in children.
- To evaluate adverse events associated with ITB treatment in pediatric patients.
Main Methods:
- Retrospective review of 46 children with baclofen pumps (2003-2013).
- Analysis of medical records for clinical characteristics, efficacy, and adverse events.
- Parental telephone interviews using a Likert scale to assess treatment efficacy.
Main Results:
- Significant reduction in spasticity in upper (median 4 to 2) and lower extremities (median 4 to 1).
- Reduced oral baclofen dosage (27.3 to 17.7 mg/day, p < 0.01).
- High parental satisfaction (mean scores 3.7 for well-being, 2.2 for function, 3.4 for ease of care); 87.1% found ITB worthwhile, 90.3% would recommend it.
Conclusions:
- Intrathecal baclofen (ITB) is effective in reducing spasticity and dystonia in children.
- ITB treatment is considered safe with a low complication rate (0.40 per pump year).
- High parental satisfaction suggests ITB is a valuable treatment option for pediatric patients.
Introduction:
Treatment of severe spasticity and dystonia with intrathecal baclofen (ITB) in children has been shown to be effective and has therefore been employed in the Region of Southern Denmark. The aim of this retrospective study was to analyse the efficacy and adverse events since ITB was introduced in 2003.
Methods:
A total of 46 children who had a baclofen pump from April 2003 to January 2013 were included. The children's medical records were reviewed and clinical characteristics, efficacy and adverse events were registered. The efficacy of treatment experienced by parents was ascertained by telephone interviews, and data were rated on a Likert scale ranging from one to five, where one was no effect and five was marked improvement.
Results:
After ITB, spasticity was reduced from a median of four to two in the upper extremities and from a median of four to one in the lower extremities. Baclofen infusion was 105.1-2,000 micrograms/day (mean 494.9 micrograms/day). Oral baclofen was reduced from 27.3 to 17.7 mg/day after ITB (p < 0.01). The parents' assessment of improvement in well-being, function and ease of care of their child had a mean score of 3.7, 2.2 and 3.4, respectively. 87.1% of parents stated that ITB had been worthwhile, and 90.3% would recommend it to other parents. Most infectious and mechanical adverse events were experienced during the first 200 days after pump implantation. The total complication rate was 0.40 per pump year.
Conclusion:
ITB resulted in reduced spasticity in children with severe spasticity and dystonia, and ITB could be considered safe. Parents' satisfaction with ITB was rated as good and most parents would recommend ITB to others.
Funding:
not relevant.
Trial Registration:
not relevant.
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