Complications of Intrathecal Baclofen Pumps in Children: Experience from a Tertiary Care Center

Ghosh, Debabrata; Mainali, Gayatra; Khera, Jena; Luciano, Mark

doi:10.1159/000358307

Cited by 53 publications

(61 citation statements)

References 32 publications

(63 reference statements)

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“…42 In another study, 4 of 119 pediatric patients (3%) in the same hospital with an intrathecal baclofen pump suffered a catheter break. 18 Dickerman et al reported that out of 110 patients at their institution with an intrathecal baclofen pump, 3 (2.7%) required a revision of the pump due to a catheter breakage. 13 Dickerman and Schneider, in a separate paper, observed a catheter break in the pump catheter neck in one of their patients, on 2 separate occasions 6 months apart.…”

Section: Discussionmentioning

confidence: 99%

Baclofen pump catheter leakage after migration of the abdominal catheter in a pediatric patient with spasticity

Dastgir

Ranalli

MacGregor

et al. 2015

PED

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The authors report an unusual case of intrathecal baclofen withdrawal due to the perforation and subsequent leakage of a baclofen pump catheter in a patient with spastic cerebral palsy. A 15-year-old boy underwent an uncomplicated placement of an intrathecal baclofen pump for the treatment of spasticity due to cerebral palsy. After excellent control of symptoms for 3 years, the patient presented to the emergency department with increasing tremors following a refill of his baclofen pump. Initial evaluation consisted of radiographs of the pump and catheter, which appeared normal, and a successful aspiration of CSF from the pump’s side port. A CT dye study revealed a portion of the catheter directly overlying the refill port and extravasation of radiopaque dye into the subfascial pocket anterior to the pump. During subsequent revision surgery, a small puncture hole in the catheter was seen to be leaking the drug. The likely cause of the puncture was an inadvertent perforation of the catheter by a needle during the refilling of the pump. This case report highlights a unique complication in a patient with an intrathecal baclofen pump. Physicians caring for these patients should be aware of this rare yet potential complication in patients presenting with baclofen withdrawal symptoms.

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Section: Discussionmentioning

confidence: 99%

Baclofen pump catheter leakage after migration of the abdominal catheter in a pediatric patient with spasticity

Dastgir

Ranalli

MacGregor

et al. 2015

PED

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“…Hypoglycorrhachia and elevated CSF protein concentrations are suggestive of the diagnosis of healthcare-associated ventriculitis or meningitis (weak, low). 26. Growth of an organism that is commonly considered a contaminant (eg, coagulase-negative staphylococcus) in enrichment broth only or on just 1 of multiple cultures in a patient with normal CSF and no fever is not indicative of healthcare-associated ventriculitis or meningitis (strong, low).…”

Section: Neurosurgery or Head Traumamentioning

confidence: 99%

“…Infections are usually more common in pediatric series [24,25]. Most reported infections are at the incision site; in one series, 3 of 49 patients developed meningitis in concert with an incisional infection, while 4 others had meningitis alone [26]. Another retrospective study identified infectious complications in 38 (18.4%) of 207 children with intrathecal infusion pumps delivering baclofen therapy [27].…”

Section: Intrathecal Infusion Pumpsmentioning

confidence: 99%

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Tunkel

Hasbun

Bhimraj

et al. 2017

Clinical Infectious Diseases

657

671

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The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.

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“…Similar frequencies have been reported by others. 20,23 Every such event gave the patient and family the option to discontinue the treatment. However, the choice was always to resume ITB.…”

Section: Discussionmentioning

confidence: 99%

Intrathecal baclofen in dyskinetic cerebral palsy: effects on function and activity

Eek

Olsson

Lindh

et al. 2017

Develop Med Child Neuro

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ITBIntrathecal baclofen ROM Range of motion AIM To investigate the effect of intrathecal baclofen (ITB) on function and activity in dyskinetic cerebral palsy (CP).METHOD A retrospective cohort study of records from 25 children (15 males, 10 females; mean age 10y 11mo, SD 4y 9mo). Five were classified in Gross Motor Function Classification level IV and 20 in level V. Parents were interviewed about activities in daily life, sitting, communication, pain, sleep, and gross and fine motor function. Differences before and 1 year after ITB were graded as positive, no change, or negative. Assessments of dystonia (using the Barry-Albright Dystonia Scale) and muscle tone (Ashworth Scale) were made. Joint range of motion (ROM) was measured.RESULTS Both dystonia and increased muscle tone, present in all participants before ITB, decreased after (p<0.001). Passive ROM was restricted, with no difference after. Parents reported improvements in activities in daily life (p<0.001), sitting (p<0.001), communication (p<0.001), and fine motor function (p=0.013), but no change in gross motor function. Before ITB, pain and disturbed sleep were reported. There was a reduction in pain (p=0.002) and sleep improved (p=0.004) after ITB.INTERPRETATION After ITB in individuals with dyskinetic CP, improvements were found in sitting, communication, and fine motor skills. There was a reduction in dystonia and muscle tone, and pain and sleep improved.Dyskinetic cerebral palsy (CP) is characterized by involuntary, uncontrolled, recurring, occasionally stereotyped movements. Primitive reflex patterns predominate and muscle tone varies. 1 There are two major patterns of movement disorder: dystonia and choreoathetosis. In a populationbased study of children born between 1991 and 1998 with dyskinetic CP in western Sweden, 39 out of 48 children were predominantly dystonic and there were also signs of spasticity in 33 out of 48.2 Primitive reflexes were found in 43 out of 48, with the asymmetric tonic neck reflex being the most prevalent. Most children with dyskinetic CP have a severe motor impairment, often accompanied by other problems, such as intellectual impairment and epilepsy, with increasing occurrence by severity of motor impairment.2 Communication is often hampered: most are without speech and rely on augmentative and alternative communication. However, in a recent study by Monbaliu et al., 3 almost half of the participants were able to communicate with unknown partners. Involuntary movement and primitive reflexes may disturb the use of augmentative and alternative communication, and optimal medical treatment and positioning is consequently vital to facilitate communication.Baclofen, a c-aminobutyric acid agonist, can be used orally and intrathecally to reduce dystonia and spasticity in children with CP, and has been shown to improve ease of care, reduce pain, and to be cost-effective. [4][5][6] The effect on choreoathetosis is seldom described. The continuous administration of baclofen directly into the intrathecal space requires the implant...

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Complications of Intrathecal Baclofen Pumps in Children: Experience from a Tertiary Care Center

Cited by 53 publications

References 32 publications

Baclofen pump catheter leakage after migration of the abdominal catheter in a pediatric patient with spasticity

Baclofen pump catheter leakage after migration of the abdominal catheter in a pediatric patient with spasticity

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Intrathecal baclofen in dyskinetic cerebral palsy: effects on function and activity

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