Experience with external pump trial prior to implantation for intrathecal baclofen in ambulatory patients with spastic cerebral palsy

Bleyenheuft, Corinne; Filipetti, Paul; Caldas, Carla Andrea Tanuri; Lejeune, Thierry

doi:10.1016/j.neucli.2007.01.004

Cited by 28 publications

(17 citation statements)

References 34 publications

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“…Other centers advocate for ITB to improve ambulation in patients with CP. In studies with careful selection criteria improved long-term ambulation is supported by the literature (73, 73, 74, 75, 76, 77, 78). …”

Section: Medical Management Of Motor Disorders In Ambulatory Patientsmentioning

confidence: 71%

New Clinical and Research Trends in Lower Extremity Management for Ambulatory Children with Cerebral Palsy

Damiano

Alter

Chambers

2009

Physical Medicine and Rehabilitation Clinics of North America

104

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SynopsisCerebral palsy is the most prevalent physical disability in childhood and includes a group of disorders with varying manifestations and levels of capability in individuals given this diagnosis. This chapter will focus on current and future intervention strategies for improving mobility and participation over the lifespan for ambulatory children with cerebral palsy (CP). The provision and integration of physical therapy, medical and orthopedic surgery management focused primarily on the lower extremities will be discussed here. Some of the newer trends are: more intense and task-related exercise strategies, greater precision in tone identification and management, and a shift towards musculoskeletal surgery that focuses more on promoting dynamic bony alignment and less on releasing or lengthening tendons. Advances in basic and clinical science and technology development are changing existing paradigms and offering renewed hope for improved functioning for children with CP who are currently facing a lifelong disability with unique challenges at each stage in life.

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Section: Medical Management Of Motor Disorders In Ambulatory Patientsmentioning

confidence: 71%

New Clinical and Research Trends in Lower Extremity Management for Ambulatory Children with Cerebral Palsy

Damiano

Alter

Chambers

2009

Physical Medicine and Rehabilitation Clinics of North America

104

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“…Previous study showed that administration of ITB may improve motor control in patients with ambulatory CP and have suggested that early placement of the ITB infusion pump is required for the prevention of orthopedic deformities and joint contracture. 8 In this case report, we observed changes in neurological signs and musculoskeletal symptoms such as spasticity, pain, and gait pattern after intrathecal bolus injection of low-dose baclofen. This showed that the ITB therapy may be effective for the management of spasticity, chronic pain, and gait disturbance.…”

Section: Discussionmentioning

confidence: 80%

Dose-dependent Changes in Gait Pattern after Intrathecal Baclofen Bolus Injection in Adult Ambulatory Cerebral Palsy: A Case Report

et al. 2015

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Intrathecal baclofen (ITB) therapy has been proven to reduce severe spasticity in cerebral palsy (CP). However, few results reported the objective gait pattern change after ITB bolus injection in adult ambulatory CP. We therefore evaluated observational and kinematic gait patterns at different ITB bolus injection doses. We performed a test trial of 3-day ITB bolus injections at doses of 12.5 μg, 25 μg, and 50 μg in ambulatory CP. We evaluated modified Ashworth scale, visual analogue scale, observational gait scale, and kinematic gait analysis after ITB bolus injection. Intrathecal administration of low-dose baclofen 25 μg was successfully used not only for the treatment of spasticity but also for the treatment of gait disturbance, whereas the higher dose baclofen 50 μg induced foot drop and deteriorated gait pattern. We experienced dose-dependent changes in gait pattern confirmed by the observational and kinematic gait assessments after ITB bolus injection in adult ambulatory CP.

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“…Complications in ITB trials have been previously reported in articles focusing on the efficacy of ITB, including unilateral radicular pain, 20 symptoms of low intracranial pressure, 6,17,23 infection at the skin level at the catheter site, and more severe complications such as positive blood cultures, 8,28 dizziness, 17,28 and drowsiness. 3,17,19,28 Deep vein thrombosis and pulmonary embolism have also been published as a case report.…”

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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Experience with external pump trial prior to implantation for intrathecal baclofen in ambulatory patients with spastic cerebral palsy

Cited by 28 publications

References 34 publications

New Clinical and Research Trends in Lower Extremity Management for Ambulatory Children with Cerebral Palsy

New Clinical and Research Trends in Lower Extremity Management for Ambulatory Children with Cerebral Palsy

Dose-dependent Changes in Gait Pattern after Intrathecal Baclofen Bolus Injection in Adult Ambulatory Cerebral Palsy: A Case Report

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

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