Weight Gain in Children With Hypertonia of Cerebral Origin Receiving Intrathecal Baclofen Therapy

McCoy, Amelia A.; Fox, Margaret A.; Schaubel, Douglas E.; Ayyangar, Rita

doi:10.1016/j.apmr.2006.07.270

Cited by 27 publications

(22 citation statements)

References 36 publications

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“…Research, showing the role of spasticity in malnutrition, used baclofen pumps in children and adolescents with hypertension of central origin in order to reduce spasticity. In addition to reducing spasticity, a statistically significant difference was found in weight gain a year before and one year after installation of a baclofenic pump (26).…”

Section: Discussionmentioning

confidence: 96%

Body Mass Index in Cerebral Palsy Patients With Various Motor Severities

2014

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Objective -To determine the nutritional status of children and adolescents with cerebral palsy (CP) in relation to the degree of functional disability. Patients and methods -This cross sectional study analyzed the nutritional status of 73 children and adolescents of both sexes suffering from CP, with an average age expressed as a median of 9.6 years (range 2.6 to 19.4). Evaluation of nutritional status in patients with CP was done on the basis of Body Mass Index (BMI). The degree of functional disability was assessed on the basis of the Gross Motor Function Classification System (GMFCS levels I-V). BMI percentiles were expressed by sex and chronological age, based on national standards in 2000 Centers for Disease Control and Prevention Growth Charts for the United States. Results -Of the total number of participants, 21.9% were underweight (BMI <5 th percentile), 11% were overweight (BMI from 85 th to 95 th percentile) and 9.6% were obese (BMI >95 th percentile). Most malnourished participants had a clinical form of quadriplegia, whereas and overweight and obese had diplegia. There is a significant negative correlation between BMI percentile and the degree of functional disability according to the GMFCS (p=0.0001). Immobile participants (GMFCS IV-V) showed a high prevalence of malnutrition (39.4%) compared to the self-mobile participants (GMFCS I-II, 4.3%). Obesity was present in 17.3% selfmoving participants (GMFCS I-II) and in 17.6% mobile participants with mobile device support (GMFCS III), and none of the immobile children were obese. Conclusion -About 40% of children and adolescents with CP have nutrition problems, where half of them are malnourished and the other half are over-nourished. Immobile children and those with quadriplegia have a higher risk for malnutrition, whereas mobile children and those with diplegia have a higher risk for over-nutritional status.

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Section: Discussionmentioning

confidence: 96%

Body Mass Index in Cerebral Palsy Patients With Various Motor Severities

2014

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“…16 In this study, oral baclofen dose was found to be a function of body mass or FFM. In addition, oral baclofen dose was related to BMI, a finding that may erroneously suggest that those who are at a high dose of oral baclofen are fatter.…”

Section: Discussionmentioning

confidence: 68%

Oral baclofen administration in persons with chronic spinal cord injury does not prevent the protective effects of spasticity on body composition and glucose homeostasis

2009

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Study design: Correlation study. Objectives: To determine the effects of oral baclofen on body composition (fat mass (FM), fat-free mass (FFM)), extra-and intracellular fluid compartments and glucose homeostasis (plasma glucose and plasma insulin concentrations) in individuals with spinal cord injury (SCI) after controlling for spasticity. Settings: Laboratory settings at the University of Michigan, MI, USA. Methods: Fifteen individuals with chronic motor complete SCI (32 ± 8 years old, 25 ± 5 kg/m 2 , C6-T11, American Spinal Injury Association A and B) underwent multifrequency bioelectrical impedance analysis to measure body composition and body fluid compartments. Spasticity of the hip, knee and ankle flexors and extensors was measured using a modified Ashworth Scale and the dose of daily oral baclofen was recorded. After overnight fasting, plasma glucose and insulin sensitivity were measured in response to an oral glucose tolerance test. Results: Oral baclofen dose was positively related to body mass index, but not to extensor or flexor spasticity. The dose of baclofen seemed to be correlated to extensor spasticity after considering spasticity per FFM. The increased dose of oral baclofen was positively associated with increased FFM, extra-and intracellular fluid compartments and total body water, but not with FM. Oral baclofen dose was negatively associated with the homeostatic model assessment index. Conclusion: Administration of oral baclofen did not attenuate the protective effects of spasticity on body composition and metabolic profile after SCI. The possibility that oral baclofen could exert an independent protective effect needs to be further investigated.

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“…13) Therefore, ITB therapy should not reduce muscular tonus more than required. Moreover, weight gain has been observed clinically in patients undergoing ITB therapy, 18,20) although published reports of this side effect are rare, but weight gain constitutes a major cause of hypometabolism. Our results also suggest that the reduction of spasticity and metabolic rate may be involved, and that adjusting the dosage of baclofen to bring resting metabolism into line with the standardized value for the age, weight, and height of the patient may enable better control of spasticity and dystonia.…”

Section: Discussionmentioning

confidence: 99%

“…Respiratory gas analyzer was used to measure resting metabolic rate before and 1 month after the procedure in the most recent 10 patients who underwent ITB therapy (Cases [13][14][15][16][17][18][19][20][21][22]. The ratio of actual measured values was evaluated against the standardized resting metabolic rate for the Japanese individuals of the same age, height, and weight as the patients.…”

mentioning

confidence: 99%