Intrathecal baclofen therapy in children with cerebral palsy: Efficacy and complications

Abstract

Murphy NA, Nicole Irwin MC, Hoff C. Intrathecal baclofen therapy in children with cerebral palsy: efficacy and complications. Arch Phys Med Rehabil 2002;83:1721-5. Objectives: To describe the efficacy of intrathecal baclofen (ITB) therapy in the management of spasticity in young children with cerebral palsy (CP) and to identify risk factors for complications. Design: Consecutive case series of 25 implanted ITB delivery systems during a 48-month period. Setting: Pediatric specialty hospital and outpatient department. Participants: Twenty-three children (age range, 4.5–17.4y) with CP (spastic diplegia in 22%; spastic quadriplegia in 61%; mixed-type diplegia in 4%; mixed-type quadriplegia in 13%). Intervention: Intrathecal baclofen therapy in children with cerebral palsy. Main Outcome Measures: Ashworth Scale scores before treatment and at 6 and 12 months after ITB therapy; frequency and nature of complications; and relation between patient characteristics and outcomes. Results: Average Ashworth scores ± standard deviation decreased from 3.26±.73 to 2.34±.83 (P≤.01) in the lower extremities and from 2.69±.79 to 2.00±.55 (P≤.05) in the upper extremities 6 months after ITB therapy and remained comparably decreased at 12 months. Explantation was required in 44% (11/25), with wound complications as the leading cause in 73% (8/11). Complications were associated with the diagnosis of mixed-type CP, as compared with pure spastic types (P≤.01). Trends suggest that children of smaller size and younger age, as well as those with gastrostomy tubes and nonambulatory status, were more likely to encounter complications necessitating explantation. Conclusion: ITB therapy effectively reduced spasticity in children with CP. However, complications necessitating explantation can occur. Further research is needed to identify criteria describing the ideal pediatric candidate for ITB. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation