Intrathecal Baclofen therapy in children and adolescents with cerebral palsy and severe generalized spasticity or dystonia

2008 ◽  
Vol 39 (01) ◽  
Author(s):  
B Ostertag
BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gunnar Hägglund ◽  
Sandra Julsen Hollung ◽  
Matti Ahonen ◽  
Guro L. Andersen ◽  
Guðbjörg Eggertsdóttir ◽  
...  

Abstract Background Spasticity is present in more than 80% of the population with cerebral palsy (CP). The aim of this study was to describe and compare the use of three spasticity reducing methods; Botulinum toxin-A therapy (BTX-A), Selective dorsal rhizotomy (SDR) and Intrathecal baclofen therapy (ITB) among children and adolescents with CP in six northern European countries. Methods This registry-based study included population-based data in children and adolescents with CP born 2002 to 2017 and recorded in the follow-up programs for CP in Sweden, Norway, Denmark, Iceland and Scotland, and a defined cohort in Finland. Results A total of 8,817 individuals were included. The proportion of individuals treated with SDR and ITB was significantly different between the countries. SDR treatment ranged from 0% ( Finland and Iceland) to 3.4% (Scotland) and ITB treatment from 2.2% (Sweden) to 3.7% (Denmark and Scotland). BTX-A treatment in the lower extremities reported 2017–2018 ranged from 8.6% in Denmark to 20% in Norway (p < 0.01). Mean age for undergoing SDR ranged from 4.5 years in Norway to 7.3 years in Denmark (p < 0.01). Mean age at ITB surgery ranged from 6.3 years in Norway to 10.1 years in Finland (p < 0.01). Mean age for BTX-A treatment ranged from 7.1 years in Denmark to 10.3 years in Iceland (p < 0.01). Treatment with SDR was most common in Gross Motor Function Classification System (GMFCS) level III, ITB in level V, and BTX-A in level I. The most common muscle treated with BTX-A was the calf muscle, with the highest proportion in GMFCS level I. BTX-A treatment of hamstring and hip muscles was most common in GMFCS levels IV-V in all countries. Conclusion There were statistically significant differences between countries regarding the proportion of children and adolescents with CP treated with the three spasticity reducing methods, mean age for treatment and treatment related to GMFCS level. This is likely due to differences in the availability of these treatment methods and/or differences in preferences of treatment methods among professionals and possibly patients across countries.


Neurosurgery ◽  
2005 ◽  
Vol 56 (1) ◽  
pp. 93-97 ◽  
Author(s):  
A Leland Albright ◽  
Susan Ferson ◽  
Signe Carlos

Abstract OBJECTIVE: Many children with cerebral palsy have chronic ventriculomegaly as a consequence of perinatal intraventricular hemorrhage or periventricular leukomalacia, without symptoms of hydrocephalus. Children with cerebral palsy who are treated with intrathecal baclofen have a higher rate of cerebrospinal fluid (CSF) leaks along the baclofen catheter than do adults treated with intrathecal baclofen. We postulated that the cause of the increased frequency of CSF leaks was increased CSF pressure, that is, occult hydrocephalus. METHODS: Lumbar punctures were performed in 24 children with cerebral palsy and asymptomatic ventriculomegaly. Their median age was 4.7 years. Mild or moderate ventriculomegaly was present in 23 children and severe ventriculomegaly was present in 1 child. RESULTS: Opening pressures were abnormally high in 23 (96%) of 24 children and ranged from 22 to 41 cm H2O (mean, 27.3 cm H2O). Opening pressures did not correlate with the extent of ventriculomegaly. CONCLUSION: Children with cerebral palsy and ventriculomegaly seem to have a high incidence of increased CSF pressure, and thus, of occult hydrocephalus. The increased pressure is probably a significant cause of the increased frequency of CSF leaks for these children during intrathecal baclofen therapy. The long-term risks of untreated increased CSF pressures in this patient population are not known but are cause for concern. Treatment with CSF shunts offers the potential of improved development, which was reported anecdotally in some children who were treated with ventriculoperitoneal shunts after their pressure was found to be increased. Prospective multicenter studies of this problem are needed.


2003 ◽  
Vol 18 (1) ◽  
pp. 26-34 ◽  
Author(s):  
Yasser Awaad ◽  
Hassan Tayem ◽  
Sharon Munoz ◽  
Steven Ham ◽  
Anne Marie Michon ◽  
...  

2012 ◽  
Vol 9 (2) ◽  
pp. 209-215 ◽  
Author(s):  
Sadahiro Nomura ◽  
Yoshiteru Kagawa ◽  
Hiroyuki Kida ◽  
Yuichi Maruta ◽  
Hirochika Imoto ◽  
...  

Object Cerebral palsy (CP) arises in the early stages of brain development and manifests as spastic paresis that is often associated with cognitive dysfunction. Available CP treatments are aimed at the management of spasticity and include botulinum toxin administration, selective dorsal rhizotomy, and intrathecal baclofen (ITB). In this study, the authors investigated whether the management of spasticity with ITB therapy affected motor function and whether the release of spasticity was associated with an improvement in intellectual function. Methods Newborn Sprague-Dawley rats were divided into the following groups: control, CP model, and CP model with ITB therapy. For the CP model, postnatal Day 7 (P7) rats were exposed to hypoxic conditions (8% O2) for 150 minutes after ligation of the right common carotid artery. In the groups receiving ITB therapy, a spinal catheter was connected to an osmotic pump filled with baclofen and placed in the spinal subarachnoid space on P21 in the early group and on P35 in the late group. A daily dose of 12 μg of baclofen was continuously administered until P49, resulting in 28 days of therapy in the early group and 14 days in the late group. Changes in spasticity in the CP and CP with ITB treatment groups were confirmed by assessing the motor evoked potential in the plantar muscle. Results In the CP group, the time required to complete a beam-walking test on P49 was significantly longer than that in the control and ITB treatment groups (4.15 ± 0.60 vs 2.10 ± 0.18 and 2.22 ± 0.22 seconds, respectively). Results of the beam-walking test are expressed as the mean ± SD. Radial arm maze performance on P49 indicated that spatial reference memory had significantly deteriorated in the CP group compared with controls (2.33 ± 0.87 vs 0.86 ± 0.90 points); moreover, working memory was also negatively affected by CP (0.78 ± 1.09 vs 0.14 ± 0.38 points). Results of the memory tests are expressed as the mean ± SE. These memory functions did not recover after ITB treatment. Conclusions Management of spasticity with ITB therapy improved the walking ability in the rat CP model. Intrathecal baclofen therapy—which reduces harmful sensory and motor stimulations caused by spasticity to more optimal levels—contributed to motor function recovery; however, it had no effect on intellectual recovery as assessed by memory performance in the rat CP model.


2012 ◽  
Vol 10 (6) ◽  
pp. 548-554 ◽  
Author(s):  
Sydney M. Hester ◽  
John F. Fisher ◽  
Mark R. Lee ◽  
Samuel Macomson ◽  
John R. Vender

Object Intrathecal baclofen therapy has been used successfully for intractable spasticity in children with cerebral palsy. Infections are rare, but they are potentially life threatening if complicated by bacteremia or meningitis. Treatment without removal of the system is desirable if it can be done safely and effectively. Methods The authors reviewed the records of 207 patients ranging from 3 to 18 years of age with cerebral palsy who underwent placement or revision of a baclofen pump. They identified 38 patients with suspected or documented infectious complications. Initial attempts were made to eradicate infection with the devices in situ in all patients. Methods and effectiveness of pump salvage were evaluated. Results Of the 38 patients identified, 13 (34.2%) had documented infections; 11 had deep wound/pocket empyemas and 2 had meningitis. Eight patients with deep wound infections received intravenous antibiotics alone. All required pump explantation. The remaining 3 patients underwent a washout procedure as well; the infection was cured in 1 patient. Both patients with meningitis received intravenous and intrathecal antibiotics, and both required device explantation. In addition, 25 patients (65.8%) had excessive or increasing wound erythema. No objective criteria to document a superficial infection were present. The wounds were considered suspicious and were managed with serial examinations and oral antibiotics. The erythema resolved in 24 of the 25 patients. Conclusions In general, observation, wound care, and oral antibiotics are sufficient for wounds that are suspicious for superficial infection. For deep-seated infection, antibiotic therapy alone is generally insufficient and explantation is required. Washout procedures can be considered, but failures are common.


2017 ◽  
Vol 31 (4) ◽  
pp. 536-539
Author(s):  
Rahul Gupta ◽  
Abhay Singh ◽  
Gangesh Gunjan ◽  
Harjinder Singh Bhatoe

Abstract Intrathecal baclofen therapy is a well-established means of treating intractable spasticity and dystonia in paediatric as well as adult population. Complications of baclofen pump placement include infection, malfunctioning and refraction to baclofen. We report a case of eight year child suffering from spasticity due to cerebral palsy, who developed pseudomeningocoele due to peri-catheter leak. Steps and precaution pertaining to pump implantation in a child are discussed. Baclofen pump insertion in a child needs some extra precautions due to non-availability of pediatric implants and poor built of the pediatric patient to adjust with a bulky device. Preventive measures should be taken to prevent peri-catheter CSF leak.


2007 ◽  
Vol 22 (1) ◽  
pp. 49-59 ◽  
Author(s):  
Gregory de Lissovoy ◽  
Louis S. Matza ◽  
Hannah Green ◽  
Meghan Werner ◽  
Terence Edgar

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