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Intrathecally administered baclofen for treatment of children with spasticity of cerebral origin.
J Neurosurg 1997; 87(3):409-14JN

Abstract

Management of severe spasticity in children is often a difficult problem. Orally administered medications generally offer limited benefits. This study examines the value of intrathecally administered baclofen in the treatment of 19 children with severe spasticity of cerebral origin: eight of whom sustained brain injury associated with trauma, near drowning, or cardiac arrest; 10 with cerebral palsy (spastic quadriplegia); and one child with Leigh's disease. At the time of entry into the study, patients ranged from 4 to 19 years of age, and all were completely dependent on caretakers for activities of daily living. Children who responded positively to a trial dose of intrathecal baclofen underwent insertion of a drug delivery system for continuous infusion. This was followed by a double-blind trial of baclofen or placebo and follow-up review at 3 and 6 months, and yearly thereafter. Seven children did not undergo pump implantation because of excess sedation or poor response. The 12 remaining children have been followed for a period of 1 to 5 years. Favorable responses were present in all 12 children as determined by the Ashworth Scale, with the greatest benefit being reduction of lower limb tone. Except in the case of one child who had reduction in lower limb tone that resulted in difficulty with transfers, the caretakers all reported significant benefits from intrathecal baclofen, with improvement in muscle tone, behavior, sitting, and general ease of care being most commonly noted. Central side effects were seen in some children who received continuous intrathecal baclofen infusion and included hypotension (two patients), bradycardia (two), apnea or respiratory depression (two), and sedation (one). During a total of 568 months of pump operation there were 10 mechanical complications, including two related to pump or side port failure and eight related to catheter kinks, extrusions, or dislodgment. Pump pocket effusion occurred in five children and a cerebrospinal fluid fistula was seen in one child. Local infection occurred in three children and meningitis in two children. The results demonstrate the potential value of continuous intrathecal baclofen infusion for treatment of severe spasticity of cerebral origin. However, this treatment can result in significant complications and more experience is required before the long-term benefits can be determined.

Authors+Show Affiliations

Department of Paediatrics, University of British Columbia, British Columbia's Children's Hospital, and Sunny Hill Health Centre for Children, Vancouver, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Controlled Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

9285607

Citation

Armstrong, R W., et al. "Intrathecally Administered Baclofen for Treatment of Children With Spasticity of Cerebral Origin." Journal of Neurosurgery, vol. 87, no. 3, 1997, pp. 409-14.
Armstrong RW, Steinbok P, Cochrane DD, et al. Intrathecally administered baclofen for treatment of children with spasticity of cerebral origin. J Neurosurg. 1997;87(3):409-14.
Armstrong, R. W., Steinbok, P., Cochrane, D. D., Kube, S. D., Fife, S. E., & Farrell, K. (1997). Intrathecally administered baclofen for treatment of children with spasticity of cerebral origin. Journal of Neurosurgery, 87(3), pp. 409-14.
Armstrong RW, et al. Intrathecally Administered Baclofen for Treatment of Children With Spasticity of Cerebral Origin. J Neurosurg. 1997;87(3):409-14. PubMed PMID: 9285607.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intrathecally administered baclofen for treatment of children with spasticity of cerebral origin. AU - Armstrong,R W, AU - Steinbok,P, AU - Cochrane,D D, AU - Kube,S D, AU - Fife,S E, AU - Farrell,K, PY - 1997/9/1/pubmed PY - 1997/9/1/medline PY - 1997/9/1/entrez SP - 409 EP - 14 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 87 IS - 3 N2 - Management of severe spasticity in children is often a difficult problem. Orally administered medications generally offer limited benefits. This study examines the value of intrathecally administered baclofen in the treatment of 19 children with severe spasticity of cerebral origin: eight of whom sustained brain injury associated with trauma, near drowning, or cardiac arrest; 10 with cerebral palsy (spastic quadriplegia); and one child with Leigh's disease. At the time of entry into the study, patients ranged from 4 to 19 years of age, and all were completely dependent on caretakers for activities of daily living. Children who responded positively to a trial dose of intrathecal baclofen underwent insertion of a drug delivery system for continuous infusion. This was followed by a double-blind trial of baclofen or placebo and follow-up review at 3 and 6 months, and yearly thereafter. Seven children did not undergo pump implantation because of excess sedation or poor response. The 12 remaining children have been followed for a period of 1 to 5 years. Favorable responses were present in all 12 children as determined by the Ashworth Scale, with the greatest benefit being reduction of lower limb tone. Except in the case of one child who had reduction in lower limb tone that resulted in difficulty with transfers, the caretakers all reported significant benefits from intrathecal baclofen, with improvement in muscle tone, behavior, sitting, and general ease of care being most commonly noted. Central side effects were seen in some children who received continuous intrathecal baclofen infusion and included hypotension (two patients), bradycardia (two), apnea or respiratory depression (two), and sedation (one). During a total of 568 months of pump operation there were 10 mechanical complications, including two related to pump or side port failure and eight related to catheter kinks, extrusions, or dislodgment. Pump pocket effusion occurred in five children and a cerebrospinal fluid fistula was seen in one child. Local infection occurred in three children and meningitis in two children. The results demonstrate the potential value of continuous intrathecal baclofen infusion for treatment of severe spasticity of cerebral origin. However, this treatment can result in significant complications and more experience is required before the long-term benefits can be determined. SN - 0022-3085 UR - https://www.unboundmedicine.com/medline/citation/9285607/Intrathecally_administered_baclofen_for_treatment_of_children_with_spasticity_of_cerebral_origin_ L2 - https://thejns.org/doi/10.3171/jns.1997.87.3.0409 DB - PRIME DP - Unbound Medicine ER -