Intrathecal Baclofen in Cerebral Palsy Movement Disorders

Abstract

Intrathecal baclofen reduces spasticity in individuals with cerebral palsy. Intrathecal doses are far lower than oral doses and the effects are considerably greater, and the side effects are fewer. Response to intrathecal baclofen must be confirmed by a screening trial before implantation of a pump for chronic infusion. Intrathecal baclofen reduces spasticity in the upper and lower extremities and is often associated with improved gait and upper extremity function. Quality of life improves for patients and caregivers. The Medtronic pump has been exceedingly reliable and typically functions for 4 or 5 years. The currently available intrathecal catheter is associated with far fewer complications than the initial catheter. Baclofen overdoses are unusual and are usually caused by pump programming errors rather than pump malfunction. Preliminary studies suggest that continuous intrathecal baclofen infusion reduces generalized dystonia in cerebral palsy. Screening to determine response of dystonia to intrathecal baclofen is by continuous infusion. The doses required to reduce dystonia are higher than those for cerebral spasticity. Additional investigations are underway to quantify the effects of continuous intrathecal baclofen infusion on communication, disability, and dystonia.

Paralisia cerebral, novas perspectivas terapêuticas

“…O baclofen pode ser usado tanto por via oral como intratecal 29 . A via intratecal é utilizada em PC com espasticidade severa, e tem a vantagem de que as doses podem ser lentamente ajustadas, e alcançar níveis maiores do que a via oral, com menores efeitos secundários.…”

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

“…Intrathecally administrated baclofen acts directly and selectively at the spinal level. 14,15 Indeed, after lumbar administration, baclofen migrates upwards but the concentrations decline along the neuraxis so that the lumbar/cisternal ratio is approximately 4/1. 16 The systemic passage is less than 1%.…”

Intrathecal baclofen in children with spastic cerebral palsy: a double‐blind, randomized, placebo‐controlled, dose‐finding study

“…14 In most previous studies, Ashworth scores of different muscles had been added to produce a summed Ashworth score. 2,10,11 This is methodologically incorrect because the Ashworth score is an ordinal level measure. 14 The VAS is a valid and reliable measure in rating pain intensity in adults and children over 6 years of age.…”

“…Furthermore, this one-point reduction had to last for two successive measurements on the same day. 2,10,11 On the day that a positive clinical response was observed, the test treatment ended and the study medication code was broken. Only if this positive clinical response was observed on the first test day did the child and caregivers have the opportunity to experience the results of the second test day before the test treatment was ended.…”

“…An experienced paediatric physiotherapist measured Ashworth scores every day before bolus administration (baseline) and 2, 4, and 6 hours afterward. 10 Ashworth scores were bilaterally assessed in seven lower-extremity muscle groups (hip adductors, flexors, and extensors; knee flexors and extensors; and ankle plantarflexors and dorsiflexors). Before catheter insertion, we selected the hip, knee, and ankle-related muscle group with highest tone on both sides, in total identifying six muscle groups per child.…”