Intrathecal baclofen therapy in children with cerebral palsy

Abstract

Since 1991, when Albright et al 1 first reported the use of intrathecal baclofen (ITB) in children with cerebral palsy (CP), numerous studies 2-4 have confirmed that treatment can reduce lower-extremity muscle tone. Murphy et al 5 recently reported on the use of continuous therapy using a single clinical measure: changes in tone based on the Ashworth Scale. This study contained no measures of function or ease of care, nor did it contain placebo controls or blinding of the raters to the treatment. Given these limitations and the fact that the pumps had to be removed in 11 of 25 subjects due to complications, Murphy's conclusion that ITB therapy is an effective tool in the management of spastic and mixed-type C P ''5(p1724) seems to be an overstatement. In a recent systematic review of for spastic and dystonic CP, Butler and Campbell 6 found consistent evidence that suppresses lower-extremity spasticity. However, their conclusions were limited because of weak research methodology and inconsistent treatment outcomes. Most studies they reviewed did not have measures of function. Adverse effects and medical complications of this treatment have included somnolence, hypotonia, seizures, meningitis, and other infections requiring pump removal. 4 In 1995, Steinbok et al7 estimated the first-year cost of continuous in children with spastic CP at Can$64,163. There is a need for randomized controlled trials with measures of function, ease of care, and cost effectiveness to establish the clinical effectiveness of continuous in children with spastic CP.