Effect of continuous intrathecal baclofen therapy in children: a systematic review

Buizer, Annemieke I.; Martens, Brian H M; Ravenhorst, Casey Grandbois van; Schoonmade, Linda J.; Becher, Jules G.; Vermeulen, R. Jeroen

doi:10.1111/dmcn.14005

Cited by 44 publications

(33 citation statements)

References 47 publications

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“…Spasticity and dystonia cause involuntary movements and postures that affect motor control and can be painful. Our review identified that the following pharmacological agents and neurosurgical procedures effectively reduce spasticity: botulinum toxin [185], intrathecal baclofen [175,176], diazepam [3•], and selective dorsal rhizotomy [209] (green lights), plus dantrolene [3•] and tizanidine [3•] are probably effective (yellow light). Supplementary local injections of alcohol probably reduce spasticity [3] (yellow light, weak positive), and local injections of phenol also probably reduce spasticity very shortterm, but side effects are common (yellow light, weak negative) [195].…”

Section: Tone Managementmentioning

confidence: 99%

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

Novak

Morgan

Fahey

et al. 2020

Curr Neurol Neurosci Rep

669

611

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Purpose of Review Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012-2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019. Recent Findings Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. Summary We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research.

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Section: Tone Managementmentioning

confidence: 99%

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

Novak

Morgan

Fahey

et al. 2020

Curr Neurol Neurosci Rep

669

611

View full text Add to dashboard Cite

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“…5 The majority of dyskinetic CP patients are severely affected and classified in Gross Motor Functioning Classification System (GMFCS) levels IV and V. These GMFCS levels correspond with having no walking ability. 7,8 Most dyskinetic CP patients for whom ITB is considered aim to gain improvement of dressing, positioning, transfers, pain, and comfort. 6 Most treatment options for dyskinetic CP are aimed at decreasing dystonia.…”

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confidence: 99%

“…6,7 Although there is some evidence for the effectiveness of ITB in reducing spasticity in CP, mainly from short-term single-bolus trial studies, to date there are only low-quality, noncontrolled studies, producing low-level evidence for ITB in the reduction of dystonia. 7,8 Most dyskinetic CP patients for whom ITB is considered aim to gain improvement of dressing, positioning, transfers, pain, and comfort. 9 There is currently inadequate evidence for the effect of ITB in dyskinetic CP on achievement of individual goals related to quality of life, activities of daily life, and participation.…”

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confidence: 99%

The Effect of Intrathecal Baclofen in Dyskinetic Cerebral Palsy: The IDYS Trial

Bonouvrié

Becher²,

Vles

et al. 2019

Annals of Neurology

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Objective Intrathecal baclofen treatment is used for the treatment of dystonia in patients with severe dyskinetic cerebral palsy; however, the current level of evidence for the effect is low. The primary aim of this study was to provide evidence for the effect of intrathecal baclofen treatment on individual goals in patients with severe dyskinetic cerebral palsy. Methods This multicenter, randomized, double‐blind, placebo‐controlled trial was performed at 2 university medical centers in the Netherlands. Patients with severe dyskinetic cerebral palsy (Gross Motor Functioning Classification System level IV–V) aged 4 to 24 years who were eligible for intrathecal baclofen were included. Patients were assigned by block randomization (2:2) for treatment with intrathecal baclofen or placebo for 3 months via an implanted microinfusion pump. The primary outcome was goal attainment scaling of individual treatment goals (GAS T score). A linear regression model was used for statistical analysis with study site as a covariate. Safety analyses were done for number and type of (serious) adverse events. Results Thirty‐six patients were recruited from January 1, 2013, to March 31, 2018. Data for final analysis were available for 17 patients in the intrathecal baclofen group and 16 in the placebo group. Mean (standard deviation) GAS T score at 3 months was 38.9 (13.2) for intrathecal baclofen and 21.0 (4.6) for placebo (regression coefficient = 17.8, 95% confidence interval = 10.4‐25.0, p < 0.001). Number and types of (serious) adverse events were similar between groups. Interpretation Intrathecal baclofen treatment is superior to placebo in achieving treatment goals in patients with severe dyskinetic cerebral palsy. ANN NEUROL 2019

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“…Buizer et al . have now published a systematic review of ITB therapy for all children, with important additional information on the effect of ITB for children with neurological conditions other than CP.…”

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confidence: 99%

“…A previous commentary in this journal noted that a better understanding of patient characteristics and how they influence goal achievement may help answer the above question. Buizer et al . also state the need for ITB researchers to address all ICF‐CY components and collaborate to pool data to determine what patient characteristics predict optimal outcome.…”

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confidence: 99%