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Continuous intrathecal baclofen infusion for spasticity of cerebral origin
A L Albright1, W B Barron, M P Fasick
1Department of Neurosurgery, Children's Hospital of Pittsburgh, PA 15213.
Insights
Continuous intrathecal baclofen infusion (CIBI) effectively reduces spasticity in patients with cerebral origin spasticity. This treatment allows for dosage adjustments, benefiting those needing some spasticity for mobility.
Area of Science:
- Neurology
- Physical Medicine and Rehabilitation
Background:
- Spasticity of cerebral origin, particularly in children with cerebral palsy, presents significant challenges.
- Managing spasticity is crucial for improving patient function and quality of life.
Purpose of the Study:
- To evaluate the efficacy of continuous intrathecal baclofen infusion (CIBI) for sustained spasticity relief.
- To assess the impact of CIBI on motor function and daily activities in patients with cerebral origin spasticity.
Main Methods:
- A prospective, unblinded trial involving 37 patients aged 5-27 with spasticity of cerebral origin.
- Continuous intrathecal baclofen infusion (CIBI) was administered for 3 to 48 months.
- Outcomes measured included muscle tone, range of motion, upper extremity function, and activities of daily living (ADLs).
Main Results:
- Significant reductions in muscle tone were observed in both upper and lower extremities at 6 and 12 months post-CIBI.
- Baclofen dosage was significantly correlated with muscle tone reduction in all extremities.
- Improvements in hamstring motion, upper extremity function, and ADLs were noted in self-care capable patients.
Conclusions:
- Continuous intrathecal baclofen infusion (CIBI) is an effective treatment for spasticity of cerebral origin.
- The ability to titrate baclofen dosage makes CIBI a valuable option for patients requiring some spasticity for ambulation and standing.
Objective:
To determine if continuous intrathecal baclofen infusion (CIBI) would provide continuous relief of spasticity in patients with spasticity of cerebral origin, especially children with cerebral palsy.
Design:
Prospective, unblinded trial, before and after CIBI.
Setting:
Children's Hospital of Pittsburgh (Pa).
Patients:
Thirty-seven patients, 5 to 27 years of age, with spasticity of cerebral origin.
Intervention:
Continuous intrathecal baclofen infusion for 3 to 48 months.
Main Outcome Measures:
Muscle tone, range of motion, upper extremity timed tasks, activities of daily living (ADLs).
Results:
Six and 12 months after CIBI, muscle tone was significantly decreased in the upper (P = .04) and lower (P = .001) extremities. There was a significant relationship between baclofen dosage and muscle tone in the upper (P = .02) and lower (P = .001) extremities. Hamstring motion, upper extremity function, and ADLs were significantly improved in 25 patients who were capable of self-care.
Conclusion:
Spasticity of cerebral origin can be effectively treated with CIBI. Because baclofen dosages can be titrated for the desired clinical response, CIBI is particularly useful for patients who need some spasticity to stand and ambulate.