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Analysis of complications in 430 consecutive pediatric patients treated with intrathecal baclofen therapy: 14-year experience.
J Neurosurg Pediatr 2014; 13(3):301-6JN

Abstract

OBJECT

This single-center study investigated adverse events that occurred in children and adolescent patients treated with intrathecal baclofen (ITB) therapy for spasticity and/or dystonia.

METHODS

In a 14-year period, 430 consecutive patients with a mean age of 13.3 ± 5.9 years received ITB over a mean follow-up period of 8.6 ± 3.8 years (range 12 months to 14 years). Eighty-nine percent of these patients had cerebral palsy. Major complications, defined as those that required a surgical intervention, were infections, CSF leaks, and device problems related to the catheter or pump. Assessing infections, the authors compared the 2 groups of patients implanted with an ITB system by either the subcutaneous or subfascial technique. The temporal distribution of events related to the catheter was also considered.

RESULTS

At least 1 complication was present in 25% of the patients: 9.3% experienced an infection, 4.9% a CSF leak, 15.1% a problem with the catheter, and 1% a problem related to the pump. Five percent of the assessed patients suffered more than 1 complication. The rate of infections was significantly lower (p < 0.001) in patients with the pump placed subfascially compared with those with the pump placed subcutaneously. A higher rate of infection was found after pump replacement compared with the first pump implantation (10.6% vs 6%, respectively). Catheter problems were the most common complication and occurred more frequently during the 1st year after the implant.

CONCLUSIONS

While ITB is an effective treatment to manage spasticity of different origins, adverse events may occur and need to be managed. The surgical procedure should be meticulous and different techniques may have a diverse impact on the infection rate, which is the most critical complication. Despite the adverse events that occurred in this study, the majority of patients were satisfied with the treatment received.

Authors+Show Affiliations

Department of Paediatric Orthopaedics, "V. Buzzi" Children's Hospital, Milan, Italy.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24404968

Citation

Motta, Francesco, and Clara E. Antonello. "Analysis of Complications in 430 Consecutive Pediatric Patients Treated With Intrathecal Baclofen Therapy: 14-year Experience." Journal of Neurosurgery. Pediatrics, vol. 13, no. 3, 2014, pp. 301-6.
Motta F, Antonello CE. Analysis of complications in 430 consecutive pediatric patients treated with intrathecal baclofen therapy: 14-year experience. J Neurosurg Pediatr. 2014;13(3):301-6.
Motta, F., & Antonello, C. E. (2014). Analysis of complications in 430 consecutive pediatric patients treated with intrathecal baclofen therapy: 14-year experience. Journal of Neurosurgery. Pediatrics, 13(3), pp. 301-6. doi:10.3171/2013.11.PEDS13253.
Motta F, Antonello CE. Analysis of Complications in 430 Consecutive Pediatric Patients Treated With Intrathecal Baclofen Therapy: 14-year Experience. J Neurosurg Pediatr. 2014;13(3):301-6. PubMed PMID: 24404968.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Analysis of complications in 430 consecutive pediatric patients treated with intrathecal baclofen therapy: 14-year experience. AU - Motta,Francesco, AU - Antonello,Clara E, Y1 - 2014/01/03/ PY - 2014/1/11/entrez PY - 2014/1/11/pubmed PY - 2014/5/3/medline SP - 301 EP - 6 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 13 IS - 3 N2 - OBJECT: This single-center study investigated adverse events that occurred in children and adolescent patients treated with intrathecal baclofen (ITB) therapy for spasticity and/or dystonia. METHODS: In a 14-year period, 430 consecutive patients with a mean age of 13.3 ± 5.9 years received ITB over a mean follow-up period of 8.6 ± 3.8 years (range 12 months to 14 years). Eighty-nine percent of these patients had cerebral palsy. Major complications, defined as those that required a surgical intervention, were infections, CSF leaks, and device problems related to the catheter or pump. Assessing infections, the authors compared the 2 groups of patients implanted with an ITB system by either the subcutaneous or subfascial technique. The temporal distribution of events related to the catheter was also considered. RESULTS: At least 1 complication was present in 25% of the patients: 9.3% experienced an infection, 4.9% a CSF leak, 15.1% a problem with the catheter, and 1% a problem related to the pump. Five percent of the assessed patients suffered more than 1 complication. The rate of infections was significantly lower (p < 0.001) in patients with the pump placed subfascially compared with those with the pump placed subcutaneously. A higher rate of infection was found after pump replacement compared with the first pump implantation (10.6% vs 6%, respectively). Catheter problems were the most common complication and occurred more frequently during the 1st year after the implant. CONCLUSIONS: While ITB is an effective treatment to manage spasticity of different origins, adverse events may occur and need to be managed. The surgical procedure should be meticulous and different techniques may have a diverse impact on the infection rate, which is the most critical complication. Despite the adverse events that occurred in this study, the majority of patients were satisfied with the treatment received. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/24404968/Analysis_of_complications_in_430_consecutive_pediatric_patients_treated_with_intrathecal_baclofen_therapy:_14_year_experience_ L2 - https://thejns.org/doi/10.3171/2013.11.PEDS13253 DB - PRIME DP - Unbound Medicine ER -