Continuous intrathecal baclofen therapy in children with cerebral palsy – when does improvement emerge?

Abstract

There seems to be a sequence of changes after introduction of continuous intrathecal baclofen in a child with cerebral palsy that may guide the multidisciplinary team in their timing of therapy during post-surgical follow-up.

Understanding the reasons for delayed referral for intrathecal baclofen therapy in pediatric patients with severe spasticity

“…Baclofen inhibits afferent nerve fibers by binding to GABA B receptors in the dorsal horn of the spinal cord, and causes presynaptic inhibition of alpha motor neurons [3]. This restores proper function between the alpha motor neurons and muscle afferents, reducing abnormal muscle activity [4]. Baclofen in the cerebrospinal fluid may also affect periventricular areas in the brain if the baclofen concentration is high enough in the ventricles.…”

Cervical catheter placement for intrathecal baclofen test dose: is it safe?

“…One retrospective study recommended directing the catheter tip to the cervical spine for better outcome in cases where spasticity involves all four limbs. The recommendations for the best practice surgical techniques for intrathecal baclofen therapy give specific positions for the intrathecal catheter tip, such as T10-12 for spastic diplegia, C5-T2 for spastic quadraplegia, and C1-4 for generalized dystonias [6,7]. However, a prospective study by Sivakumar et al [8] showed no correlation between the intrathecal catheter tip position and the baclofen maintenance dose in relation to the response to spasticity and outcome.…”

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

“…Children and adults with dyskinetic CP spend most of their wake time sitting or sedentary, which makes the task of finding an optimal sitting position one of the most important goals for treatment in this group. According to Ramstad et al, 21 adjustments of sitting equipment in children with ITB need to be made after changes in dystonia and spasticity, depending on doses. 21 There was no change in ROM in the group after ITB.…”

“…According to Ramstad et al, 21 adjustments of sitting equipment in children with ITB need to be made after changes in dystonia and spasticity, depending on doses. 21 There was no change in ROM in the group after ITB. However, no change can sometimes be positive, when deterioration is usually to be expected, which is often the case in CP.…”

“…The doses in the present study varied, similar to those reported in other studies. 20,21 Ramstad et al 21 reported doses ranging from 86 to 576 after 18 months of treatment in a group with mixed CP types. Individuals with dyskinetic CP are expected to require higher doses of ITB than those with spastic CP.…”