Intrathecal baclofen in the management of spasticity due to cerebral palsy

Vloeberghs, Michael; Keetley, Rachel; Morton, Richard E.

doi:10.1080/13638490400011165

Cited by 19 publications

(20 citation statements)

References 5 publications

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“…26,28 After 83 test treatments, Vloeberghs et al reported five nonresponders and six children with a response not fulfilling the expectations of the caregivers. 28 It is unclear whether they tried only one ITB bolus per child or also higher doses in non-responders. We would encourage our colleagues to report more comprehensively on the design, results, and complications of ITB test treatments in children.…”

Section: Discussionmentioning

confidence: 99%

“…31 However, information on the children's weight and the incidence of side effects and complications was either limited or absent. 4,[26][27][28][29][30] Not all studies had a 100% success rate of test treatment. 26,28 After 83 test treatments, Vloeberghs et al reported five nonresponders and six children with a response not fulfilling the expectations of the caregivers.…”

Section: Discussionmentioning

confidence: 99%

“…4,[26][27][28][29][30] Not all studies had a 100% success rate of test treatment. 26,28 After 83 test treatments, Vloeberghs et al reported five nonresponders and six children with a response not fulfilling the expectations of the caregivers. 28 It is unclear whether they tried only one ITB bolus per child or also higher doses in non-responders.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, all studies focused on the pump implantation and follow-up without much attention on the preceding test treatment. Apart from Vloeberghs et al, 28 who used an ITB 30µg bolus in the smallest children, test treatments started with an adult 50µg ITB bolus. 4,27,29 We would expect many side effects with this high starting dose, because we and others noted side effects in response to ITB bolus doses as low as 20 and 10µg respectively.…”

Section: Discussionmentioning

confidence: 99%

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Intrathecal baclofen in children with spastic cerebral palsy: a double‐blind, randomized, placebo‐controlled, dose‐finding study

Hoving¹,

Raak²,

Spincemaille³

et al. 2007

Develop Med Child Neuro

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Intrathecal baclofen (ITB) therapy can be very effective in the treatment of intractable spasticity, but its effectiveness and safety have not yet been thoroughly studied in children with cerebral palsy (CP). The aims of this double‐blind, randomized, placebo‐controlled, dose‐finding study were to select children eligible for continuous ITB infusion, to assess the effective ITB bolus dose, and to evaluate the effects, side effects, and complications. Outcome measures included the original Ashworth scale and the Visual Analogue Scale for individually formulated problems. We studied nine females and eight males, aged between 7 and 16 years (mean age 13y 2mo [SD 2y 9mo]). Twelve children had spastic CP and five had spastic‐dyskinetic CP. One child was classified on the Gross Motor Function Classification System at Level III, two at Level I V, and 14 at Level V. The test treatment worked successfully for all 17 children with an effective ITB bolus dose of 12.5μg in one, 20μg in another, 25μg in 10, and 50μg in five children. ITB significantly reduced muscle tone, diminished pain, and facilitated ease of care. The placebo did not have these effects. Nine side effects of ITB were registered, including slight lethargy in seven children. Fourteen children had symptoms of lowered cerebrospinal fluid pressure. We conclude that ITB bolus administration is effective and safe for carefully selected children with intractable spastic CP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Intrathecal baclofen in children with spastic cerebral palsy: a double‐blind, randomized, placebo‐controlled, dose‐finding study

Hoving¹,

Raak²,

Spincemaille³

et al. 2007

Develop Med Child Neuro

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“…3,17,19,28 Deep vein thrombosis and pulmonary embolism have also been published as a case report. 12 In a retrospective report by Vloeberghs et al 29 that focused on the outcomes of ITB pump implantation in spasticity due to cerebral palsy, 10% of 85 patients undergoing a trial had spinal tap syndrome with no other complications reported. All of these were catheter trials.…”

Section: Discussionmentioning

confidence: 99%

Intrathecal baclofen trials: complications and positive yield in a pediatric cohort

Sayer

Lumsden

Perides

et al. 2016

PED

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OBJECT Intrathecal baclofen (ITB) is an effective management option for childhood hypertonia. Given the potential complications of implanted ITB pumps, trials of ITB are usually performed as part of the workup for ITB pumps. Two methods are used for ITB trials, lumbar puncture (LP) and catheter insertion into the intrathecal space. Little has been written to date on the number of positive trials and complications in trials. This study aimed to report the outcomes and complications in ITB trials for childhood hypertonia (dystonia, spastic, or mixed). METHODS A retrospective case notes review was conducted of all patients who underwent ITB trials at the Evelina London Children’s Hospital between 2005 and 2012 (inclusive). Positive trials were defined as a reduction in Modified Ashworth Scale by a minimum of 1 point in at least 2 muscle groups and improvement reported by the caregivers in the areas of goals agreed upon between professionals and the families. RESULTS Our patient group comprised children with dystonia (n = 7), mixed spasticity/dystonia (n = 29), spasticity (n = 4), and pain (n = 1). A total of 47 trials were attempted in 41 children. Forty trials were successfully completed, with 39 being positive. Thirty-three were catheter trials, and 14 were LPs. The overall complication rate in the 47 attempted trials was 53%: 61% in catheter trials, and 36% in LP trials. This difference was not statistically significant. The most common complications were vomiting (n = 9) and CSF leak (n = 4). The most serious complication was meningitis (n = 1) in a catheter trial. No patients experienced a permanent injury. CONCLUSIONS There is a high risk of minor self-limiting complications with ITB trials, which needs to be factored into the decision process of progression to trials. The rate of positive trials in this study was 98%, of which 21% did not progress to pump implantation. While the authors would still advocate for ITB trials prior to ITB pump insertion to aid parental decision-making, this figure suggests that with good patient selection, ITB pumps could be placed without a preceding trial.

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Intrathecal baclofen for treating spasticity in children with cerebral palsy

Hasnat

Rice

2015

Cochrane Database of Systematic Reviews

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There is some limited short-term evidence that intrathecal baclofen is an effective therapy for reducing spasticity in children with cerebral palsy. The effect of intrathecal baclofen on long-term spasticity outcomes is less certain.The validity of the evidence for the effectiveness of intrathecal baclofen in treating spasticity in children with cerebral palsy from the studies in the review is constrained by the small sample sizes of the studies and methodological issues in some studies.Spasticity is a impairment in the domain of body structure and function. Consideration must also be given to the broader context in determining whether intrathecal baclofen therapy is effective. The aim of therapy may be, for example, to improve gross motor function, to increase participation at a social role level, to improve comfort, to improve the ease of care by others or to improve the overall quality of life of the individual. Intrathecal baclofen may improve gross motor function in children with cerebral palsy, but more reliable evidence is needed to determine this.There is some evidence that intrathecal baclofen improves ease of care and the comfort and quality of life of the individuals receiving it, but again small sample sizes and methodological issues in the studies mean that these results should be interpreted with caution.Further evidence of the effectiveness of intrathecal baclofen for treating spasticity, increasing gross motor function and improving comfort, ease of care and quality of life is needed from other investigators in order to validate these results.The short duration of the controlled studies included in this review did not allow for the exploration of questions regarding whether the subsequent need for orthopaedic surgery in children receiving intrathecal baclofen therapy is altered, or the safety and the economic implications of intrathecal baclofen treatment when long-term therapy is administered via an implanted device. Controlled studies are not the most appropriate study design to address these questions, cohort studies may be more appropriate.

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Intrathecal baclofen in the management of spasticity due to cerebral palsy

Abstract: Intrathecal baclofen is a cornerstone in the treatment of spasticity in children. However, further research is required to set criteria for treatment. This paper offers insight into the national act on baclofen and the experience at the Nottingham University Hospital.

Cited by 19 publications

References 5 publications

Intrathecal baclofen in children with spastic cerebral palsy: a double‐blind, randomized, placebo‐controlled, dose‐finding study

Intrathecal baclofen in children with spastic cerebral palsy: a double‐blind, randomized, placebo‐controlled, dose‐finding study

Intrathecal baclofen trials: complications and positive yield in a pediatric cohort

Intrathecal baclofen for treating spasticity in children with cerebral palsy

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