Efficacy of intrathecal baclofen therapy in children with intractable spastic cerebral palsy: A randomised controlled trial

Hoving, Marjanke A.; Raak, E.P.M. van; Spincemaille, G.H.; Palmans, Liesbeth J.; Becher, Jules G.; Vles, Johan S.H.

doi:10.1016/j.ejpn.2008.04.013

Cited by 95 publications

(109 citation statements)

References 24 publications

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“…As per the existing literature, also supported by our study, the ITB pump is effective in the management of spasticity and/or dystonia in children [3,5,6,8,9,16,26,27,28,29]. Of 119 cases in our series, only 5 (4.2%) patients' parents were not happy with the response in spite of the therapeutic ITB dose.…”

Section: Discussionsupporting

confidence: 78%

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Complications of Intrathecal Baclofen Pumps in Children: Experience from a Tertiary Care Center

et al. 2013

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Background/Aims: Intrathecal baclofen (ITB) therapy is useful in treating spasticity and dystonia but it has many complications, more so in children. The main aim of the study was to look at the complications of ITB pumps in children with the goal of future prevention. Methods: Charts of all patients ≤21 years with an ITB pump, implanted by a single pediatric neurosurgeon, at a single center, between 1996 and 2011 were reviewed retrospectively. Data regarding an ITB test trial were also recorded. Results: During 1996-2011, 119 children (mean age 13.2 years) underwent ITB pump placement; 84% had spastic quadriplegic cerebral palsy. The gross motor function classification system level was ≥4 for most. The pump was removed in 5 (4.2%) patients due to inefficacy. The mean follow-up was 38 months. Mechanical complications requiring pump and/or catheter revision occurred in 19.3% and infections in an additional 21.8%. Seven patients (6%) had meningitis. No complication was noted after 72 months of initial pump insertion, even after pump reinsertion. Conclusion: There is a need for better infection control as well as better pump, catheter and surgical technology to lower the complications of ITB pumps in children.

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Section: Discussionsupporting

confidence: 78%

“…The efficacy of ITB pumps for spasticity management has been proven by many studies, both in children and in adults [3,4,5,6]. This procedure is also helpful in the management of medically refractory secondary dystonias [7,8].…”

Section: Introductionmentioning

confidence: 99%

Complications of Intrathecal Baclofen Pumps in Children: Experience from a Tertiary Care Center

et al. 2013

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“…1,2,9,11,23,24,26,33,43 Although it has been very effective in treating spasticity, the therapy does entail certain risks, 4,14,21,22 with approximately 25%-30% of patients experiencing a complication. 4,[22][23][24] These complications can be from dosing (overdose or underdose), mechanical failure of the pump or catheter, and infection of the hardware or local tissues. 4,14,21,22,44 Infections, leakage of CSF, and catheterrelated issues are the most common complications.…”

Section: Discussionmentioning

confidence: 99%

Baclofen pump catheter leakage after migration of the abdominal catheter in a pediatric patient with spasticity

Dastgir

Ranalli

MacGregor

et al. 2015

PED

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The authors report an unusual case of intrathecal baclofen withdrawal due to the perforation and subsequent leakage of a baclofen pump catheter in a patient with spastic cerebral palsy. A 15-year-old boy underwent an uncomplicated placement of an intrathecal baclofen pump for the treatment of spasticity due to cerebral palsy. After excellent control of symptoms for 3 years, the patient presented to the emergency department with increasing tremors following a refill of his baclofen pump. Initial evaluation consisted of radiographs of the pump and catheter, which appeared normal, and a successful aspiration of CSF from the pump’s side port. A CT dye study revealed a portion of the catheter directly overlying the refill port and extravasation of radiopaque dye into the subfascial pocket anterior to the pump. During subsequent revision surgery, a small puncture hole in the catheter was seen to be leaking the drug. The likely cause of the puncture was an inadvertent perforation of the catheter by a needle during the refilling of the pump. This case report highlights a unique complication in a patient with an intrathecal baclofen pump. Physicians caring for these patients should be aware of this rare yet potential complication in patients presenting with baclofen withdrawal symptoms.

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“…The efficacy of intrathecal baclofen has been supported by various studies [2,[9][10][11]. The mostfrequent complications include infections, CSF leaks, and catheter malfunctions.…”

Section: Resultsmentioning

confidence: 99%

Unexpected Baclofen Subdural Infusion in a Patient who Carries an Internal Pump for Intrathecal Infusion: A Case Report

Barca¹,

Montopoli²

2016

Int J Clin Pharmacol Pharmacother

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Objective: We report a case of intrathecal baclofen infusion pump implantation complicated by migration of the catheter tip. Subdural migration, of the intrathecal catheter tip, in who has been having an infusion pump for years and is experiencing swinging dosage related effects it is not the first thing one takes into consideration. A case of subdural migration of intrathecal catheters is presented.Methods: Subsequent X-ray and computed tomography evaluations of the catheter system revealed pooling of contrast medium outside of the intrathecal space, in the lumbar subdural region of the vertebral channel and therefore migration of the pump catheter tip. Results:The spinal catheter was subsequently revised, and the patient made a full recovery. From few days after surgery, the patients spasticity improved and up to now (six months later), he has been experiencing no further complications, is requiring an average baclofen dosage of 150 mcg/day. Conclusion:The possible migration of an intrathecal catheter into the subdural space should be included as differential diagnosis in a patient who experiences a lack of drug effect, despite increases in dosage, after years from pump implantation. We recommend the use of the CT scan, after contrast injection, to detect the distal catheter tip and confirm a normal diffusion into the subarachnoid space.

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Efficacy of intrathecal baclofen therapy in children with intractable spastic cerebral palsy: A randomised controlled trial

Cited by 95 publications

References 24 publications

Complications of Intrathecal Baclofen Pumps in Children: Experience from a Tertiary Care Center

Complications of Intrathecal Baclofen Pumps in Children: Experience from a Tertiary Care Center

Baclofen pump catheter leakage after migration of the abdominal catheter in a pediatric patient with spasticity

Unexpected Baclofen Subdural Infusion in a Patient who Carries an Internal Pump for Intrathecal Infusion: A Case Report

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