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Intrathecal Baclofen Therapy in Children: Testing, Dose-Finding, and Complications-A Single-Center Experience.
Andrea Held1, Camilla de Laurentis1, Claire Mietton2
1Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
Pediatric Neurology
|February 11, 2026
Summary
Optimizing intrathecal baclofen (ITB) therapy for spasticity requires a personalized, multistep dose-finding process. Individual patient needs and variability are crucial for successful treatment outcomes in pediatric patients.
Area of Science:
- Neurology
- Pediatric Medicine
- Pharmacology
Background:
- Intrathecal baclofen (ITB) is a GABA agonist used to treat spasticity in pediatric and adult patients.
- ITB treatment requires gradual dose adjustments for optimal patient outcomes and functional improvement.
- Individualized goals and specific pathologies necessitate tailored therapeutic approaches.
Purpose of the Study:
- To review the experience with intrathecal baclofen pump implantation in pediatric patients.
- To analyze the dose-finding process, including test doses and complications.
- To identify any significant differences between patient subgroups.
Main Methods:
- Retrospective review of 43 pediatric patients implanted with ITB pumps from August 2021 to December 2024.
- Analysis of test dose administration, dose titration, and associated complications.
- Subgroup analysis to detect statistically significant differences.
Main Results:
- 35 patients received a bolus via lumbar puncture; 6 via a subcutaneous reservoir.
- Average initial dose was 69 mcg/day, with a mean increase of 52% during follow-up.
- Cumulative revision rates at 30 days, 3 months, and 6 months were 6.9%, 7.7%, and 11.8%, respectively. No significant subgroup differences were found.
Conclusions:
- The dose-finding process for ITB is lengthy and involves multiple steps.
- High interindividual variability in response necessitates a personalized approach to dose titration.
- Tailoring ITB dosage is essential for optimizing spasticity management in pediatric patients.
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