scholarly journals Treatment of spasticity in children and adolescents with cerebral palsy in Northern Europe: a CP-North registry study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gunnar Hägglund ◽  
Sandra Julsen Hollung ◽  
Matti Ahonen ◽  
Guro L. Andersen ◽  
Guðbjörg Eggertsdóttir ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Children And Adolescents ◽  
Botulinum Toxin A ◽  
Intrathecal Baclofen ◽  
Population Based ◽  
Treatment Methods ◽  
Dorsal Rhizotomy ◽  
Intrathecal Baclofen Therapy ◽  
Level I ◽  
Gmfcs Level

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.

Test–Retest Reliability and Construct Validity of the German Translation of the Gait Outcome Assessment List (GOAL) Questionnaire for Children with Ambulatory Cerebral Palsy

2021 ◽  
Author(s):  
Michaela V. Bonfert ◽  
Evelyn Jelesch ◽  
A. Sebastian Schroeder ◽  
Julia Hartmann ◽  
Helene Koenig ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Children And Adolescents ◽  
Motor Function ◽  
Related Function ◽  
Retest Reliability ◽  
Level Ii ◽  
Children With Cerebral Palsy ◽  
Level I ◽  
Test Retest Reliability ◽  
Gmfcs Level

AbstractThe Gait Outcome Assessment List (GOAL) is a patient or caregiver-reported assessment of gait-related function across different domains of the International Classification of Functioning, Disability, and Health (ICF) developed for ambulant children with cerebral palsy (CP). So far, the questionnaire is only available in English. The aim of this study was to translate the GOAL into German and to evaluate its reliability and validity by studying the association between GOAL scores and gross motor function as categorized by the gross motor function classification system (GMFCS) in children with cerebral palsy (CP). The GOAL was administered to primary caregivers of n = 91 children and adolescents with CP (n = 32, GMFCS levels I; n = 27, GMFCS level II; and n = 32, GMFCS level III) and n = 15 patients were capable of independently completing the whole questionnaire (GMFCS level I). For assessing test–retest reliability, the questionnaire was completed for a second time 2 weeks after the first by the caregivers of n = 36 patients. Mean total GOAL scores decreased significantly with increasing GMFCS levels with scores of 71 (95% confidence interval [CI]: 66.90–74.77) for GMFCS level I, 56 (95% CI: 50.98–61.86) for GMFCS level II, and 45 (95% CI: 40.58–48.48) for GMFCS level III, respectively. In three out of seven domains, caregivers rated their children significantly lower than children rated themselves. The test–retest reliability was excellent as was internal consistency given the GOAL total score. The German GOAL may serve as a much needed patient-reported outcome measure of gait-related function in ambulant children and adolescents with CP.

scholarly journals Self-versus Proxy-Reported Pain in Children with Cerebral Palsy: A Population-Based Registry Study of 3783 Children

2020 ◽  
Vol 11 ◽  
pp. 215013272091152 ◽  
Author(s):  
Gunnar Hägglund ◽  
Amanda Burman-Rimstedt ◽  
Tomasz Czuba ◽  
Ann I. Alriksson-Schmidt
Keyword(s):  
Logistic Regression ◽  
Cerebral Palsy ◽  
Classification System ◽  
Population Based ◽  
Registry Study ◽  
Cross Sectional ◽  
Marginal Effects ◽  
Level I ◽  
Average Marginal Effects ◽  
Gmfcs Level

Objective: To assess how the prevalence of pain in a population-based sample of children and adolescents with cerebral palsy (CP) differ based on self- or proxy reporting. Methods: This cross-sectional registry study included 3783 children (58% boys), 1 to 18 years old, enrolled in the Swedish follow-up program for CP. Logistic regression was used to regress source of reporting (self or proxy) on the presence of general pain adjusted for age, sex, Gross Motor Function Classification System (GMFCS), and Communication Function Classification System (CFCS) levels, including marginal effects between source of reporting and adjusted covariates. Results: The pain item was self-reported in 45%, proxy-reported in 51%, and information was missing in 3%. Pain was reported in 44% of those who self-reported and in 41% of those who proxy-reported ( P = .04). The logistic regression showed that the average marginal effects of proxy versus self-reported pain were lower among children at GMFCS level IV (−0.14, 95% CI −0.17 to −0.03) and CFCS level I (−0.09, CI −0.16 to −0.01) and higher at CFCS level III (0.11, CI 0.00-0.22). There were no statistically significant differences in average marginal effects related to age, sex, or the other GMFCS and CFCS levels between proxy and self-reporting. Conclusions: Pain was more often reported by those who self-reported. However, after adjusting for age, sex, CFCS level, and GMFCS level, the proportion of reported pain was almost equal between self and proxy-reporting. Assuming that the self- and proxy-reported groups were not significantly different on relevant factors not controlled for the results indicate that presence of pain is equally reported by children and parents.

Occult Hydrocephalus in Children with Cerebral Palsy

Neurosurgery ◽  
2005 ◽  
Vol 56 (1) ◽  
pp. 93-97 ◽  
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.

scholarly journals Reliability and Validity of Data for 2 Newly Developed Shuttle Run Tests in Children With Cerebral Palsy

2006 ◽  
Vol 86 (8) ◽  
pp. 1107-1117 ◽  
Author(s):  
Olaf Verschuren ◽  
Tim Takken ◽  
Marjolijn Ketelaar ◽  
Jan Willem Gorter ◽  
Paul JM Helders
Keyword(s):  
Cerebral Palsy ◽  
Intraclass Correlation ◽  
Reliability And Validity ◽  
Correlation Coefficients ◽  
Treadmill Test ◽  
Children With Cerebral Palsy ◽  
Level I ◽  
Test Retest Reliability ◽  
Shuttle Run ◽  
Gmfcs Level

Abstract Background and Purpose. The purpose of this study was to examine the reliability and validity of data obtained with 2 newly developed shuttle run tests (SRT-I and SRT-II) to measure aerobic power in children with cerebral palsy (CP) who were classified at level I or II on the Gross Motor Function Classification System (GMFCS). The SRT-I was developed for children at GMFCS level I, and the SRT-II was developed for children at GMFCS level II. Subjects. Twenty-five children and adolescents with CP (10 female, 15 male; mean age=11.9 years, SD=2.9), classified at GMFCS level I (n=14) or level II (n=11), participated in the study. Methods. To assess test-retest reliability of data for the 10-m shuttle run tests, the subjects performed the same test within 2 weeks. To examine validity, the shuttle run tests were compared with a GMFCS level–based treadmill test designed to measure peak oxygen uptake. Results. Statistical analyses revealed test-retest reliability for exercise time (number of levels completed) (intraclass correlation coefficients of .97 for the SRT-I and .99 for the SRT-II) and reliability for peak heart rate attained during the final level (intraclass correlation coefficients of .87 for the SRT-I and .94 for the SRT-II). High correlations were found for the relationship between data for both shuttle run tests and data for the treadmill test (r=.96 for both). Discussion and Conclusion. The results suggest that both 10-m shuttle run tests yield reliable and valid data. Moreover, the shuttle run tests have advantages over a treadmill test for children with CP who are able to walk and run (GMFCS level I or II). [Verschuren O, Takken T, Ketelaar M, et al. Reliability and validity of data for 2 newly developed shuttle run tests in children with cerebral palsy. Phys Ther. 2006;86:1107–1117.]

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

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.

Functional Assessment Following Intrathecal Baclofen Therapy in Children With Spastic Cerebral Palsy

2003 ◽  
Vol 18 (1) ◽  
pp. 26-34 ◽  
Author(s):  
Yasser Awaad ◽  
Hassan Tayem ◽  
Sharon Munoz ◽  
Steven Ham ◽  
Anne Marie Michon ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Functional Assessment ◽  
Intrathecal Baclofen ◽  
Spastic Cerebral Palsy ◽  
Intrathecal Baclofen Therapy

Effects of intrathecal baclofen therapy on motor and cognitive functions in a rat model of cerebral palsy

2012 ◽  
Vol 9 (2) ◽  
pp. 209-215 ◽  
Author(s):  
Sadahiro Nomura ◽  
Yoshiteru Kagawa ◽  
Hiroyuki Kida ◽  
Yuichi Maruta ◽  
Hirochika Imoto ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Intrathecal Baclofen ◽  
Early Group ◽  
Walking Test ◽  
Treatment Groups ◽  
Intrathecal Baclofen Therapy ◽  
Days Of Therapy ◽  
The Mean ◽  
Late Group

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.

Evaluation of salvage techniques for infected baclofen pumps in pediatric patients with cerebral palsy

2012 ◽  
Vol 10 (6) ◽  
pp. 548-554 ◽  
Author(s):  
Sydney M. Hester ◽  
John F. Fisher ◽  
Mark R. Lee ◽  
Samuel Macomson ◽  
John R. Vender
Keyword(s):  
Cerebral Palsy ◽  
Wound Care ◽  
Intrathecal Baclofen ◽  
Infectious Complications ◽  
Oral Antibiotics ◽  
Superficial Infection ◽  
General Observation ◽  
Intrathecal Baclofen Therapy ◽  
Deep Wound ◽  
Life Threatening

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.

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