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.

scholarly journals Intrathecal baclofen and motor function in cerebral palsy

2011 ◽  
Vol 53 (5) ◽  
pp. 443-448 ◽  
Author(s):  
FRANCESCO MOTTA ◽  
CLARA E ANTONELLO ◽  
CECILIA STIGNANI
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Intrathecal Baclofen

Delaying an Appendectomy: Is it Safe?

2012 ◽  
Vol 78 (8) ◽  
pp. 897-900 ◽  
Author(s):  
Kamal Nagpal ◽  
Navalkishor Udgiri ◽  
Niraj Sharma ◽  
Ernesto Curras ◽  
John Morgan Cosgrove ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Outcomes ◽  
Early Group ◽  
Perforation Rate ◽  
Exclusion Criteria ◽  
Open Conversion ◽  
Urgent Operation ◽  
The Mean ◽  
The Relationship ◽  
Late Group

Appendicitis has always been an indication for an urgent operation, as delay is thought to lead to disease progression and therefore worse outcomes. Recent studies suggest that appendectomy can be delayed slightly without worse outcomes, however the literature is contradictory. The goal of our study was to examine the relationship between this delay to surgery and patient outcomes. We reviewed all patients that underwent an appendectomy in our institution from January 2009 to December 2010. We recorded the time of surgical diagnosis from when both the surgical consult and the CT scan (if done) were completed. The delay from surgical diagnosis to incision was measured, and patients were divided into two groups: early (≤6 hours delay) and late (>6 hours delay). Outcome measures were 30-day complication rate, length of stay, perforation rate, and laparoscopic to open conversion rate. Three hundred and seventy-seven patients had appendectomies in the study period, and 35 patients were excluded as per the exclusion criteria leaving 342 in the study: 269 (78.7%) in the early group and 73 (21.3%) in the late group. Complications occurred in 21 patients (6.1%) with no difference between the groups: 16/253 (5.9%) in the early group and 5/73 (6.8%) in the late group ( P = 0.93, χ2). The mean (± standard deviation) length of stay was 86.1 ± 67.1 hours in the early group, and 95.9 ± 73.0 hours in the late group. This difference was not significant ( P = 0.22). Delaying an appendectomy more than 6 hours, but less than 24 hours from diagnosis is safe and does not lead to worse outcomes. This can help limit the disruption to the schedules of both the surgeon and the operating room.

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 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

scholarly journals Intrathecal baclofen infusion and subsequent orthopedic surgery in patients with spastic cerebral palsy

1998 ◽  
Vol 4 (1) ◽  
pp. E7 ◽  
Author(s):  
Peter C. Gerszten ◽  
A. Leland Albright ◽  
Graham F. Johnstone
Keyword(s):  
Cerebral Palsy ◽  
Lower Extremity ◽  
Orthopedic Surgery ◽  
Intrathecal Baclofen ◽  
Orthopedic Procedures ◽  
Spastic Cerebral Palsy ◽  
Spastic Diplegia ◽  
Spastic Quadriplegia ◽  
Orthopedic Operation ◽  
The Mean

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.

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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