269 - Intrathecal Baclofen Therapy for Cerebral Palsy

Abstract

The intrathecal delivery of baclofen, via an implanted pump, has been in use for over 30 years. After initial use in adults with acquired spasticity, most often due to spinal cord injury or multiple sclerosis, the indications for this therapy were extended to include spasticity secondary to cerebral palsy (CP), both in children and in adults. Since then, intrathecal baclofen (ITB) therapy has become widespread in CP, on a global basis. Baclofen, a γ-aminobutyric acid type B (GABAB) receptor agonist, is produced as both an oral agent and an intrathecal agent. Oral baclofen carries the risk of adverse effects, which for children commonly include excessive sedation and academic difficulties, both of which are much less prevalent in ITB therapy. However, the short half-life of the drug in cerebrospinal fluid mandates the use of a continuous delivery system. As a result of this need, the majority of clinical experience and published literature involves the use of the programmable SynchroMed infusion pump (Medtronic, Inc, Minneapolis). ITB therapy is most commonly used in children with spastic or spastic-dystonic quadriplegic CP, especially for nonambulatory patients. It is often used for children who are not candidates for selective dorsal rhizotomy, a procedure that is best suited for children with spastic diplegic CP. The effects of ITB on tone are long-standing, with high patient satisfaction. The greatest risk in pump placement is device infection. Strategies to minimize this risk are discussed.