Continous intrathecal baclofen (cITB) therapy terminates spinal spasms mimicking tonic seizures in a teenager with severe spastic cerebral palsy with total body involvement and cervical dystonia

Intrathecal baclofen infusion (IBI) is an effective treatment for spasticity secondary to cerebral palsy (CP). The authors retrospectively reviewed the need for orthopedic surgery of the lower extremities in 48 patients with spastic CP who were treated with IBI. Forty pumps were placed in patients suffering from spastic quadriplegia (84%) and eight (16%) in patients with spastic diplegia. The patients' ages ranged from 5 to 43 years (mean 15 years). The mean follow-up period was 53 months (range 22-94 months). The mean baclofen dosage was 306 μg/day (range 25-1350 μg/day). At the time of pump placement, subsequent orthopedic surgery was planned in 28 patients (58%); however, only 10 (21%) underwent orthopedic surgery after IBI therapy. In all 10 cases, the surgical procedure was planned at the time of initial evaluation for IBI therapy. In the remaining 18 patients, who did not subsequently undergo their planned orthopedic operation, it was believed that their lower-extremity spasticity had improved to the degree that orthopedic intervention was no longer indicated. In addition, although six patients had undergone multiple orthopedic operations before their spasticity was treated, no patient required more than one orthopedic operation after IBI treatment for their spasticity. The authors conclude that IBI for treatment of spastic CP reduces the need for subsequent orthopedic surgery for the effects of lower-extremity spasticity. In patients with spastic CP and lower-extremity contractures, spasticity should be treated before orthopedic procedures are performed.

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Long-term therapy with intrathecal baclofen improves quality of life in children with severe spastic cerebral palsy

European Journal of Paediatric Neurology ◽

10.1016/j.ejpn.2017.01.016 ◽

2017 ◽

Vol 21 (3) ◽

pp. 565-569 ◽

Cited By ~ 14

Author(s):

Tanja Kraus ◽

Kathrin Gegenleitner ◽

Martin Svehlik ◽

Michael Novak ◽

Gerhardt Steinwender ◽

...

Keyword(s):

Quality Of Life ◽

Cerebral Palsy ◽

Intrathecal Baclofen ◽

Spastic Cerebral Palsy ◽

Term Therapy ◽

Long Term Therapy

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Intrathecal Baclofen for Management of Spastic Cerebral Palsy: Multicenter Trial

Journal of Child Neurology ◽

10.1177/088307380001500201 ◽

2000 ◽

Vol 15 (2) ◽

pp. 71-77 ◽

Cited By ~ 181

Author(s):

Richard Gilmartin ◽

Derek Bruce ◽

Bruce B. Storrs ◽

Rick Abbott ◽

Linda Krach ◽

...

Keyword(s):

Cerebral Palsy ◽

Intrathecal Baclofen ◽

Multicenter Trial ◽

Spastic Cerebral Palsy

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Baclofen pump catheter leakage after migration of the abdominal catheter in a pediatric patient with spasticity

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.2.peds14501 ◽

2015 ◽

Vol 16 (3) ◽

pp. 335-339 ◽

Cited By ~ 3

Author(s):

Amer Dastgir ◽

Nathan J. Ranalli ◽

Theresa L. MacGregor ◽

Philipp R. Aldana

Keyword(s):

Emergency Department ◽

Cerebral Palsy ◽

Unusual Case ◽

Intrathecal Baclofen ◽

Spastic Cerebral Palsy ◽

Potential Complication ◽

Baclofen Withdrawal ◽

Subsequent Revision ◽

Excellent Control ◽

Side Port

The authors report an unusual case of intrathecal baclofen withdrawal due to the perforation and subsequent leakage of a baclofen pump catheter in a patient with spastic cerebral palsy. A 15-year-old boy underwent an uncomplicated placement of an intrathecal baclofen pump for the treatment of spasticity due to cerebral palsy. After excellent control of symptoms for 3 years, the patient presented to the emergency department with increasing tremors following a refill of his baclofen pump. Initial evaluation consisted of radiographs of the pump and catheter, which appeared normal, and a successful aspiration of CSF from the pump’s side port. A CT dye study revealed a portion of the catheter directly overlying the refill port and extravasation of radiopaque dye into the subfascial pocket anterior to the pump. During subsequent revision surgery, a small puncture hole in the catheter was seen to be leaking the drug. The likely cause of the puncture was an inadvertent perforation of the catheter by a needle during the refilling of the pump. This case report highlights a unique complication in a patient with an intrathecal baclofen pump. Physicians caring for these patients should be aware of this rare yet potential complication in patients presenting with baclofen withdrawal symptoms.

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