Pharmacologic interventions for management of spasticity in cerebral palsy

O’Donnell, Maureen; Armstrong, R. B.

doi:10.1002/(sici)1098-2779(1997)3:2<204::aid-mrdd12>3.0.co;2-z

Cited by 15 publications

(10 citation statements)

References 55 publications

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“…High doses of oral baclofen can lead to unwanted side effects such as confusion, weakness, and nausea 2 . However, if baclofen is administered intrathecally, a much lower dose is required as the drug is delivered directly to the site of action and, hence, there is a lower incidence of side effects 2,7 …”

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confidence: 99%

“…2 However, if baclofen is administered intrathecally, a much lower dose is required as the drug is delivered directly to the site of action and, hence, there is a lower incidence of side effects. 2,7 Intrathecal baclofen (ITB) is generally administered via a programmable pump implanted in the abdomen with a refillable reservoir and a catheter tunnelled subcutaneously to the lower lumbar spinal area and then into the intrathecal space. 5 The tip of the catheter is usually placed at T10 to T12 for individuals with spastic diplegia, C5 to T2 for those with spastic quadriparesis ⁄ quadriplegia, and C1 to C4 for those with generalized dystonia.…”

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confidence: 99%

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Use of intrathecal baclofen therapy in ambulant children and adolescents with spasticity and dystonia of cerebral origin: a systematic review

McCartney

Lewis

et al. 2011

Developmental Medicine &Amp; Child Neurology

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ITB Intrathecal baclofenAIM Studies on the use of intrathecal baclofen (ITB) for ambulant adults with spasticity and ⁄ or dystonia of cerebral origin are scarce, and are even more limited for children and adolescents. This systematic review investigates the use of ITB to improve walking, transfer ability, and gross motor activities in ambulant children and adolescents with spasticity and ⁄ or dystonia of cerebral origin.METHOD Electronic databases (MEDLINE, CINAHL, PsycINFO, EMBASE, full Cochrane Library, and PEDro) were searched from the earliest date available until March 2011 using combined subject headings and free text if supported by the databases. Studies were included if they had examined individuals who: (1) received ITB therapy by any method (bolus injection, an external delivery system, or an implanted pump); (2) had spasticity and ⁄ or dystonia of cerebral origin; (3) were able to ambulate with or without a walking device, i.e. individuals with cerebral palsy (CP) who were in levels I to III of the Gross Motor Function Classification System or individuals with similar functional mobility if they did not have CP; and (4) were aged 18 years or under. Publications in English in peer-reviewed journals reporting any type of research design, except reviews and expert opinions, were included. Studies were excluded if participants had spasticity and ⁄ or dystonia of spinal origin and if baclofen was administered only orally. Studies that compared ITB with other interventions such as botulinum toxin were also excluded.RESULTS Two independent reviewers scored 16 studies against the guidelines for developing systematic reviews from the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM).INTERPRETATION Fifteen studies were of levels IV or V evidence and only one of level II according to the evidence levels of the AACPDM guidelines, but all were of low quality. No study was found on the use of ITB in ambulant children or adolescents with dystonia of cerebral origin. Not all studies used objective outcome measures to assess the ambulation, transfer ability, and gross motor activities of the participants. A proportion of participants showed improvement in all these areas but adverse events were common. A proportion of participants compromised their ambulatory and transfer abilities after ITB. There was no evidence to support the clinical use of ITB in ambulant individuals with hypertonicity without further rigorous longitudinal studies.Spasticity is a velocity-dependent increase in resistance of a muscle when stretched, 1 and is one of the common signs of an upper motor neuron lesion. Spasticity can make movements difficult and inefficient, which in turn contributes to the formation of contractures, discomfort, and muscle spasms, and thus interferes with activities of daily living such as feeding, toileting, dressing, and positioning. 2,3 One of the pharmacological agents used in treating spasticity is baclofen, an agonist of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). 4 Baclo...

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confidence: 99%

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confidence: 99%

Use of intrathecal baclofen therapy in ambulant children and adolescents with spasticity and dystonia of cerebral origin: a systematic review

McCartney

Lewis

et al. 2011

Developmental Medicine &Amp; Child Neurology

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“…42,85 These drugs include baclofen, dantrolene, clonazepam, diazepam, and tizanidine. 57,84 The value of oral baclofen has been limited by the common occurrence of sedation at the dose levels needed for relief of spasticity. Baclofen has been used orally since the early 1970s as an antispasmodic agent.…”

Section: Nonneurosurgical Optionsmentioning

confidence: 99%

“…Baclofen, whose chemical name is 4-amino-3-(4-chlorophenyl)-butyric acid, is a synthetic GABA agonist that acts selectively on both pre-and postsynaptic GABA B receptors to reduce excitatory synaptic transmission. 5,57 Dantrolene inhibits the release of calcium from the sarcoplasmic reticulum, and thus weakens muscles, thereby reducing tone. The drug is absorbed well after oral administration, but has low lipid solubility and does not cross the blood-brain barrier readily.…”

Section: Nonneurosurgical Optionsmentioning

confidence: 99%

Selection of treatment modalities in children with spastic cerebral palsy

Steinbok¹

2006

Neurosurgical Focus

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✓ The purpose of this report was to outline the various options currently used for treatment of spastic cerebral palsy (CP) and to discuss factors involved in selecting the appropriate treatment modalities for the individual child. In a review of the literature and his personal observations, the author presents an outline of treatment options and the criteria for using each. Therapeutic options include the following: physiotherapy; occupational therapy; oral spasmolytic and antidystonic drugs; botulinum toxin injections; orthopedic procedures; continuous infusion of intrathecal baclofen (ITB); selective dorsal rhizotomy (SDR); and selective peripheral neurotomy. The most commonly used neurosurgical procedures are ITB pump placement and SDR, and these are discussed in the most detail. The author's personal schema for assessment of the child to determine the nature of the hypertonia, the impact of the hypertonia, and the appropriate therapeutic intervention is presented. There are factors that help guide the optimal treatment modalities for the child with spastic CP. The treatment of these children is optimized in the setting of a multidisciplinary team.

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“…Everyday pain should be treated with a graduated analgesical approach, according to the World Health Organization's analgesic ladder, with steps ranging from the use of nonopioids to opioids, plus adjuvant medications for increasing or persistant pain (24). Spasticity should be approached with a treatment plan specific to the underlying condition, including physical and occupational therapy, and antispasticity medications such as baclofen and botulinum toxin (25). Opioids, with or without benzodiazepine adjuvants, should be used for acute or procedural pain.…”

Section: Painmentioning

confidence: 99%

The child with multiple impairments

2000

Paediatrics &Amp; Child Health

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Pharmacologic interventions for management of spasticity in cerebral palsy

Cited by 15 publications

References 55 publications

Use of intrathecal baclofen therapy in ambulant children and adolescents with spasticity and dystonia of cerebral origin: a systematic review

Use of intrathecal baclofen therapy in ambulant children and adolescents with spasticity and dystonia of cerebral origin: a systematic review

Selection of treatment modalities in children with spastic cerebral palsy

The child with multiple impairments

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