A prospective study of pain pre- and post-intrathecal baclofen pump implant in children with cerebral palsy

Background Planovalgus deformity of the foot is common among cerebral palsy (CP) patients. It is an upcoming topic with debate and controversy that require further studies. Many clinical studies involving arthroereisis have shown acceptable results in short- and mid-term follow-up. The aim of this work was to evaluate the outcome of arthroereisis using a conventional screw placed percutaneously across the talocalcaneal articulation for the treatment of moderate planovalgus deformity in children with CP. Methods Between 2015 and 2018, a prospective study was conducted including 23 CP patients with bilateral flexible planovalgus deformity with follow-up period ranging from 24 to 40 months (mean of 36.7 months). The radiological and clinical outcomes were assessed. The patient/parent outcome was evaluated using the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). Results The results showed statistically significant improvement in both radiological and clinical data as well as patient’s symptoms and parent’s satisfaction. Conclusion Results obtained from literature from the past decades after arthroereisis for the correction of moderate planovalgus deformity in CP patients are promising. The few studies reported on that procedure shared the same harmony with our study giving a chance to be a good alternative to joint destructive procedures. Our technique is simple, effective, economical, and minimally invasive if used in selected pediatric CP patients. Levels of Evidence Therapeutic, Level IV

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Exertion during caregiving for children with cerebral palsy following intrathecal baclofen

Developmental Medicine & Child Neurology ◽

10.1111/dmcn.5_12886 ◽

2015 ◽

Vol 57 ◽

pp. 78-78

Keyword(s):

Cerebral Palsy ◽

Intrathecal Baclofen ◽

Children With Cerebral Palsy

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Occult Hydrocephalus in Children with Cerebral Palsy

Neurosurgery ◽

10.1227/01.neu.0000144779.32401.a2 ◽

2005 ◽

Vol 56 (1) ◽

pp. 93-97 ◽

Cited By ~ 15

Author(s):

A Leland Albright ◽

Susan Ferson ◽

Signe Carlos

Keyword(s):

Cerebral Palsy ◽

Periventricular Leukomalacia ◽

Intrathecal Baclofen ◽

Multicenter Studies ◽

Csf Shunts ◽

Csf Pressure ◽

Intrathecal Baclofen Therapy ◽

Children With Cerebral Palsy ◽

Csf Leaks

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.

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Access to Intrathecal Baclofen Treatment for Children with Cerebral Palsy in European Countries: An SCPE Survey Reveals Important Differences

Neuropediatrics ◽

10.1055/s-0040-1701659 ◽

2020 ◽

Vol 51 (02) ◽

pp. 129-134

Author(s):

Kate Himmelmann ◽

Magnus Påhlman ◽

Guro L. Andersen ◽

Torstein Vik ◽

Daniel Virella ◽

...

Keyword(s):

Cerebral Palsy ◽

Gross Domestic Product ◽

Sex Difference ◽

Motor Function ◽

Classification System ◽

Intrathecal Baclofen ◽

Population Based ◽

Treatment Access ◽

Significant Difference ◽

Children With Cerebral Palsy

Abstract Aim The aim is to study access to intrathecal baclofen (ITB) for children with cerebral palsy (CP) in Europe, as an indicator of access to advanced care. Methods Surveys were sent to CP registers, clinical networks, and pump manufacturers. Enquiries were made about ITB treatment in children born in 1990 to 2005 by sex, CP type, level of gross motor function classification system (GMFCS) and age at the start of treatment. Access to ITB was related to the country's gross domestic product (GDP) and % GDP spent on health. Results In 2011 population-based data from Sweden, Norway, England, Portugal, Slovenia, and Denmark showed that 114 (3.4%) of 3,398 children with CP were treated with ITB, varying from 0.4 to 4.7% between centers. The majority of the children were at GMFCS levels IV-V and had bilateral spastic CP. In Sweden, dyskinetic CP was the most commonly treated subtype. Boys were more often treated with ITB than girls (p = 0.014). ITB was reported to be available for children with CP in 25 of 43 countries. Access to ITB was associated with a higher GDP and %GDP spent on health (p < 0.01). Updated information from 2019 showed remaining differences between countries in ITB treatment and sex difference in treated children was maintained. Conclusion There is a significant difference in access to ITB for children with CP across Europe. More boys than girls are treated. Access to ITB for children with CP is associated with GDP and percent of GDP spent on health in the country.

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