Topical Review: Baclofen in the Treatment of Cerebral Palsy

Abstract

Baclofen, a gamma-aminobutyric acid agonist, acts at the spinal cord level to impede the release of excitatory neurotransmitters that cause spasticity. Oral baclofen improves cerebral spasticity mildly, but its activity is limited because of its poor lipid solubility. Cerebrospinal fluid baclofen levels after intrathecal administration are many times higher than those achieved after oral administration. Continuous intrathecal baclofen infusion has been used to treat cerebral spasticity in two patient groups: in older ambulatory children with inadequate underlying leg strength, and in patients with severe spasticity in both the upper and lower extremities. Responsiveness to intrathecal baclofen is confirmed by test injections before insertion of a programmable subcutaneous pump. Continuous intrathecal baclofen infusion dosages vary from 27 to 800 micrograms/day. Continuous intrathecal baclofen infusion reduces spasticity in the upper and lower extremities, and improves upper extremity function and activities of daily living but has no effect on athetosis in the dosages used to treat spasticity. Complications related to the intrathecal catheter occur in approximately 20% of patients, and infection requiring pump removal occurs in approximately 5%. Preliminary studies indicate that continuous intrathecal baclofen infusion alleviates some forms of generalized dystonia associated with cerebral palsy.

Treatment of spasticity with intrathecal Baclofen administration: long-term follow-up, review of 40 patients

“…This has not been previously reported, probably because most tests used 100 mg as maximal dose. Albright 28 considers that 85% of the patients respond to doses between 50 and 100 mg. Test doses above 100 mg have been considered to be dangerous and useless because response to such doses would imply treatment doses superior to 1000 mg. 6 This has not been our experience. We never observed side effects in the patients tested with doses superior to 100 mg and follow-up doses never exceeded 1000 mg/day.…”

“…3,43 The use of refill kits, including bacteria filters, has decreased their incidence. 37,44 The perioperative antibioprophylaxis, suggested by some authors, 28,29 is not yet established. Besides classical treatment (antibiotics, removal, and then replacement of the pump), some authors have reported new approaches with instillation of appropriate antibiotics into the reservoir 44 and intrathecal perfusion of antibiotics while continuing ITB, 45 with success.…”

Has botulinum toxin type A a place in the treatment of spasticity in spinal cord injury patients?

“…Often, the daily doses must be increased over time. 23,24,29 lntrathecal administration of baclofen can o er many advantages for patients who experience intolerable side e ects at e ective doses of oral medications. Delivering the medication directly to the target site means that cerebrospinal uid levels can be much higher than with oral administration which crosses the blood-brain barrier poorly.…”

Modulation of Involuntary Movements in Cerebral Palsy with Acupuncture

“…Among the most common in current use are intrathecal baclofen [6][7][8][9] and intramuscular botox. More recently deep brain stimulation has been used for dystonia.…”