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Effect of continuous intrathecal baclofen therapy in children: a systematic review
Annemieke I Buizer1, Brian H M Martens2, Casey Grandbois van Ravenhorst1
1Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, the Netherlands.
Insights
Continuous intrathecal baclofen (ITB) therapy shows potential for reducing spasticity and improving care in children with cerebral palsy. However, current evidence is limited, necessitating further high-quality research.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Clinical Neuroscience
Background:
- Cerebral palsy (CP) and other neurological conditions often involve significant spasticity and dystonia.
- Intrathecal baclofen (ITB) therapy is a treatment option for managing severe muscle tone disorders.
- Understanding the comprehensive effects of continuous ITB in pediatric populations is crucial for optimizing care.
Purpose of the Study:
- To systematically review the existing literature on the efficacy and outcomes of continuous intrathecal baclofen (ITB) therapy in children.
- To evaluate the impact of ITB on various functional domains as defined by the International Classification of Functioning, Disability and Health: Children and Youth (ICF-CY).
- To identify gaps in the current evidence base and suggest future research directions.
Main Methods:
- A systematic review of four major electronic databases (PubMed, Embase, CINAHL, Cochrane Library) was performed.
- Literature published from the inception of the databases up to September 2017 was included.
- Studies focusing on continuous ITB interventions and reporting outcomes across ICF-CY components were analyzed.
Main Results:
- Thirty-three studies were included, with only one providing Level II evidence; most were Level IV or V.
- Continuous ITB demonstrated potential benefits in reducing spasticity and dystonia in children with CP.
- Improvements in ease of care and quality of life were suggested, though evidence quality was low.
Conclusions:
- The current evidence for continuous ITB in children with CP is of low scientific quality.
- While non-controlled studies suggest efficacy in reducing spasticity and dystonia, robust evidence is lacking.
- Further high-quality, large-scale, and long-term studies are essential to confirm the benefits of ITB across all ICF-CY domains.
Aim:
To investigate the effects of continuous intrathecal baclofen (ITB) therapy in children with cerebral palsy (CP) and other neurological conditions.
Method:
This systematic review was conducted using standardized methodology, searching four electronic databases (PubMed, Embase, CINAHL, Cochrane Library) for relevant literature published between inception and September 2017. Included studies involved continuous ITB as an intervention and outcome measures relating to all International Classification of Functioning, Disability and Health: Children and Youth (ICF-CY) components.
Results:
Thirty-three studies were identified, of which one, including 17 children with spastic CP, produced level II evidence, and the others, mainly non-controlled cohort studies, level IV and V. Outcomes at body function level were most frequently reported. Results suggest continuous ITB may be effective in reducing spasticity and dystonia in CP, as well as other neurological conditions, and may improve the ease of care and quality of life of children with CP, but the level of evidence is low.
Interpretation:
Despite three decades of applying ITB in children and a relatively large number of studies investigating the treatment effects, a direct link has not yet been demonstrated because of the low scientific quality of the primary studies. Further investigation into the effects of continuous ITB at all levels of the ICF-CY is warranted. Although large, controlled trials may be difficult to realize, national and international collaborations may provide opportunities. Also, multicentre prospective cohort studies with a long-term follow-up, employing harmonized outcome measures, can offer prospects to expand our knowledge of the effects of continuous ITB therapy in children.
What This Paper Adds:
There is low-level evidence for continuous intrathecal baclofen (ITB) in children with cerebral palsy. Continuous ITB is effective in reducing spasticity and dystonia in non-controlled cohort studies. Evaluation of individual goals and systematic assessment of long-term effects in large cohort studies are required.
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