Abstract
Murphy NA, Nicole Irwin MC, Hoff C. Intrathecal baclofen therapy in children with
cerebral palsy: efficacy and complications. Arch Phys Med Rehabil 2002;83:1721-5.
Objectives: To describe the efficacy of intrathecal baclofen (ITB) therapy in the management
of spasticity in young children with cerebral palsy (CP) and to identify risk factors
for complications.
Design: Consecutive case series of 25 implanted ITB delivery systems during a 48-month period.
Setting: Pediatric specialty hospital and outpatient department.
Participants: Twenty-three children (age range, 4.5–17.4y) with CP (spastic diplegia in 22%; spastic
quadriplegia in 61%; mixed-type diplegia in 4%; mixed-type quadriplegia in 13%).
Intervention: Intrathecal baclofen therapy in children with cerebral palsy.
Main Outcome Measures: Ashworth Scale scores before treatment and at 6 and 12 months after ITB therapy;
frequency and nature of complications; and relation between patient characteristics
and outcomes.
Results: Average Ashworth scores ± standard deviation decreased from 3.26±.73 to 2.34±.83
(
P≤.01) in the lower extremities and from 2.69±.79 to 2.00±.55 (
P≤.05) in the upper extremities 6 months after ITB therapy and remained comparably
decreased at 12 months. Explantation was required in 44% (11/25), with wound complications
as the leading cause in 73% (8/11). Complications were associated with the diagnosis
of mixed-type CP, as compared with pure spastic types (
P≤.01). Trends suggest that children of smaller size and younger age, as well as those
with gastrostomy tubes and nonambulatory status, were more likely to encounter complications
necessitating explantation.
Conclusion: ITB therapy effectively reduced spasticity in children with CP. However, complications
necessitating explantation can occur. Further research is needed to identify criteria
describing the ideal pediatric candidate for ITB.
© 2002 by the American Congress of Rehabilitation Medicine and the American Academy
of Physical Medicine and Rehabilitation
Keywords
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Article Info
Footnotes
☆Supported in part by the Agency for Healthcare Research and Quality (grant no. P20HS11825-01).
☆☆No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.
★Reprint requests to Nancy A. Murphy, MD, Dept of Pediatrics, University of Utah, 50 N Medical Dr, Salt Lake City, UT, 84132, e-mail: [email protected].
★★Suppliers
♢a. SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.
♢♢b. Medtronic Inc, 710 Medtronic Pkwy, Minneapolis, MN 55432-5604.
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© 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
