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Intrathecal Baclofen Therapy

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Cerebral Palsy

Abstract

Intrathecal baclofen (ITB) therapy is a good therapeutic, evidence-based option and effective treatment for spasticity in children with cerebral palsy. It has also been used in children with dystonic cerebral palsy. ITB results in decreased spasticity, with the lower extremities more relieved than the upper extremities, fewer spasms, improvement in ankle clonus and increased range of motion and improved ambulation in children with spastic diplegia. As well, ITB therapy can help in reducing contractures, improving functional abilities and facilitating patient care by parents and caregivers. ITB therapy involves the surgical implantation of a programmable pump in the abdomen with a catheter tracking into the spinal subarachnoid space and the baclofen venting into the cerebrospinal fluid. There can be surgical complications, as well as complications related to the patient’s medical condition, to the hardware implanted and to the medication. Despite this, the overall perceptions of ITB therapy have been found to be positive with most parents or caregivers satisfied and would go through the process again if needed for their child.

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References

  1. Albright AL. Intrathecal baclofen in cerebral palsy movement disorders. J Child Neurol. 1996;11(Suppl 1):29–S35.

    Article  Google Scholar 

  2. Hasnat MJ, Rice JE. Intrathecal baclofen for treating spasticity in children with cerebral palsy. Cochrane Database Syst Rev. 2015;11:1–47.

    Google Scholar 

  3. Hoving MA, van Raak EP, Spincemaille GH, et al. and Dutch Study Group on Child Spasticity. Efficacy of intrathecal baclofen therapy in children with intractable spastic cerebral palsy: a randomised controlled trial. Eur J Paediatr Neurol. 2009;13:240–6.

    Google Scholar 

  4. Vles GF, Soudant DL, Hoving MA, et al. Long-term follow-up on continuous intrathecal baclofen therapy in non-ambulant children with intractable spastic cerebral palsy. Eur J Paediatr Neurol. 2013;17:639–44.

    Article  PubMed  Google Scholar 

  5. Hoving MA, van Raak EP, Spincemaille GH, Dutch Study Group on Child Spasticity. Safety and one-year efficacy of intrathecal baclofen therapy in children with intractable spastic cerebral palsy. Eur J Paediatr Neurol. 2009;13:247–56.

    Article  PubMed  Google Scholar 

  6. Pin TW, McCartney L, Lewis J, Waugh M-C. Use of intrathecal baclofen therapy in ambulant children and adolescents with spasticity and dystonia of cerebral origin: a systematic review. Dev Med Child Neurol. 2011;53:885–95.

    Article  PubMed  Google Scholar 

  7. von Koch CS, Park TS, Steinbok P, et al. Selective posterior rhizotomy and intrathecal baclofen for the treatment of spasticity. Pediatr Neurosurg. 2001;35:57–65.

    Article  Google Scholar 

  8. Albright AL, Barry MJ, Shafron DH, Ferson SS. Intrathecal baclofen for generalized dystonia. Dev Med Child Neurol. 2001;43:652–7.

    Article  CAS  PubMed  Google Scholar 

  9. Turner M, Nguyen HS, Cohen-Gadol AA. Intraventricular baclofen as an alternative to intrathecal baclofen for intractable spasticity or dystonia: outcomes and technical considerations. J Neurosurg Pediatr. 2012;10:315–9.

    Article  PubMed  Google Scholar 

  10. Rocque BG, Albright AL. Intraventricular vs intrathecal baclofen for secondary dystonia: a comparison of complications. Neurosurgery. 2012;70(2 Suppl Operative):321–5.

    PubMed  Google Scholar 

  11. Bleyenheuft C, Filipetti P, Caldas C, Lejeune T. Experience with external pump trial prior to implantation for intrathecal baclofen in ambulatory patients with spastic cerebral palsy. Neurophysiol Clin. 2007;37:23–8.

    Article  CAS  PubMed  Google Scholar 

  12. Sayer C, Lumsden DE, Perides S, et al. Intrathecal baclofen trials: complications and positive yield in a pediatric cohort. J Neurosurg Pediatr. 2016;17:240–5.

    Article  Google Scholar 

  13. Kopell BH, Sala D, Doyle WK, et al. Subfascial implantation of intrathecal baclofen pumps in children: technical note. Neurosurgery. 2001;49:753–7.

    CAS  PubMed  Google Scholar 

  14. Thakur SK, Rubin BA, Harter DH. Long-term follow-up for lumbar intrathecal baclofen catheters placed using the paraspinal subfascial technique. J Neurosurg Pediatr. 2016;17:357–60.

    Article  PubMed  Google Scholar 

  15. Motta F, Antonello CE. Comparison between an Ascenda and a silicone catheter in intrathecal baclofen therapy in pediatric patients: analysis of complications. J Neurosurg Pediatr. 2016;18:493–8.

    Article  PubMed  Google Scholar 

  16. Liu JK, Walker ML. Posterior cervical approach for intrathecal baclofen pump insertion in children with previous spinal fusions: technical note. J Neurosurg Pediatr. 2005;102:119–22.

    Article  Google Scholar 

  17. Dziurzynski K, Mcleish D, Ward M, Iskandar BJ. Placement of baclofen pumps through the foramen magnum and upper cervical spine. Childs Nerv Syst. 2006;22:270–3.

    Article  PubMed  Google Scholar 

  18. Ughratdar I, Muquit S, Ingale H, et al. Cervical implantation of intrathecal baclofen pump catheter in children with severe scoliosis. J Neurosurg Pediatr. 2012;10:34–8.

    Article  PubMed  Google Scholar 

  19. Grabb PA, Guin-Renfroe S, Meythaler JM. Midthoracic catheter tip placement for intrathecal baclofen administration in children with quadriparetic spasticity. Neurosurgery. 1999;45:833–7.

    Article  CAS  PubMed  Google Scholar 

  20. Albright AL, Turner M, Pattisapu JV. Best-practice surgical techniques for intrathecal baclofen therapy. J Neurosurg Pediatr. 2006;104:233–9.

    Article  Google Scholar 

  21. Bollo RJ, Gooch JL, Walker ML. Stereotactic endoscopic placement of third ventricle catheter for long-term infusion of baclofen in patients with secondary generalized dystonia. J Neurosurg Pediatr. 2012;10:30–3.

    Article  PubMed  Google Scholar 

  22. Shirley KW, Kothare S, Piatt JH Jr, Adirim TA. Intrathecal baclofen overdose and withdrawal. Pediatr Emerg Care. 2006;22:258–61.

    Article  PubMed  Google Scholar 

  23. Duhon BS, MacDonald JD. Infusion of intrathecal baclofen for acute withdrawal. J Neurosurg. 2007;107:878–80.

    Article  PubMed  Google Scholar 

  24. Vender JR, Hester S, Waller JL, et al. Identification and management of intrathecal baclofen pump complications: a comparison of pediatric and adult patients. J Neurosurg Pediatr. 2006;104:9–15.

    Article  Google Scholar 

  25. Spader HS, Bollo RJ, Bowers CA, Riva-Cambrin J. Risk factors for baclofen pump infection in children: a multivariate analysis. J Neurosurg Pediatr. 2016;17:756–62.

    Article  PubMed  Google Scholar 

  26. Borowski A, Littleton AG, Borkhuu B, et al. Complications of intrathecal baclofen pump therapy in pediatric patients. J Pediatr Orthop. 2010;30:76–81.

    Article  PubMed  Google Scholar 

  27. Motta F, Buonaguro V, Stignani C. The use of intrathecal baclofen pump implants in children and adolescents: safety and complications in 200 consecutive cases. J Neurosurg Pediatr. 2007;107:32–5.

    Article  Google Scholar 

  28. Motta F, Antonello CE. Analysis of complications in 430 consecutive pediatric patients treated with intrathecal baclofen therapy: 14-year experience. J Neurosurg Pediatr. 2014;13:301–6.

    Article  PubMed  Google Scholar 

  29. Ward A, Hayden S, Dexter M, Scheinberg A. Continuous intrathecal baclofen for children with spasticity and/or dystonia—goal attainment and complications associated with treatment. J Paediatr Child Health. 2009;45:720–6.

    Article  PubMed  Google Scholar 

  30. Bayhan IA, P Sees J, Nishnianidze T, et al. Infection as a complication of intrathecal baclofen treatment in children with cerebral palsy. J Pediatr Orthop. 2016;36:305–9.

    Article  PubMed  Google Scholar 

  31. Ghosh D, Mainali G, Khera J, Luciano M. Complications of intrathecal baclofen pumps in children: experience from a tertiary care center. Pediatr Neurosurg. 2013;49:138–44.

    Article  PubMed  Google Scholar 

  32. Kallweit U, Harzheim M, Marklein G, et al. Successful treatment of methicillin-resistant Staphylococcus Aureus meningitis using linezolid without removal of intrathecal pump. J Neurosurg. 2007;107:651–3.

    Article  CAS  PubMed  Google Scholar 

  33. McCall TD, MacDonald JD. Cervical catheter tip placement for intrathecal baclofen administration. Neurosurgery. 2006;59:634–40.

    Article  PubMed  Google Scholar 

  34. Tubbs RS, Law C, Oakes WJ, Grabb PA. Acquired Chiari I malformation following baclofen pump placement in a child. J Neurosurg Pediatr. 2004;101:211–3.

    Article  Google Scholar 

  35. Fulkerson DH, Boaz JC, Luerssen TG. Interaction of ventriculoperitoneal shunt and baclofen pump. Childs Nerv Syst. 2007;23:733–8.

    Article  PubMed  Google Scholar 

  36. Burn SC, Zeller R, Drake JM. Do baclofen pumps influence the development of scoliosis in children? J Neurosurg Pediatr. 2010;5:195–9.

    Article  PubMed  Google Scholar 

  37. Ginsburg GM, Lauder AJ. Progression of scoliosis in patients with spastic quadriplegia after the insertion of an intrathecal baclofen pump. Spine. 2007;32:2745–50.

    Article  PubMed  Google Scholar 

  38. Senaran H, Shah SA, Presedo A, et al. The risk of progression of scoliosis in cerebral palsy patients after intrathecal baclofen therapy. Spine. 2007;32:2348–54.

    Article  PubMed  Google Scholar 

  39. Shilt JS, Lai LP, Cabrera MN, et al. The impact of intrathecal baclofen on the natural history of scoliosis in cerebral palsy. J Pediatr Orthop. 2008;28:284–70.

    Article  Google Scholar 

  40. Brochard S, Remy-Neris O, Filipetti P, Bussel B. Intrathecal baclofen infusion for ambulant children with cerebral palsy. Pediatr Neurol. 2009;40:265–70.

    Article  PubMed  Google Scholar 

  41. Stempien L, Tsai T. Intrathecal baclofen pump use for spasticity: a clinical survey. Am J Phys Med Rehabil. 2000;79:536–41.

    Article  CAS  PubMed  Google Scholar 

  42. Bensmail D, Quera Salva MA, Roche N, et al. Effect of intrathecal baclofen on sleep and respiratory function in patients with spasticity. Neurology. 2006;67:1432–6.

    Article  CAS  PubMed  Google Scholar 

  43. Kraus T, Gegenleitner K, Svehlik M, et al. Long-term therapy with intrathecal baclofen improves quality of life in children with severe spastic cerebral palsy. Eur J Paediatr Neurol. 2017;21:565–9.

    Article  PubMed  Google Scholar 

  44. Ramstad K, Jahnsen R, Lofterod B, Skjeldal O. Continuous intrathecal baclofen therapy in children with cerebral palsy—when does improvement emerge? Acta Paediatr. 2010;99:1661–5.

    Article  CAS  PubMed  Google Scholar 

  45. Brennan PM, Whittle IR. Intrathecal baclofen therapy for neurological disorders: a sound knowledge base but many challenges remain. Br J Neurosurg. 2008;22:508–19.

    Article  CAS  PubMed  Google Scholar 

  46. Sgouros S, Seri S. The effect of intrathecal baclofen on muscle co-contraction in children with spasticity of cerebral origin. Pediatr Neurosurg. 2002;37:225–30.

    Article  CAS  PubMed  Google Scholar 

  47. de Lissovoy G, Matza LS, Green H, et al. Cost-effectiveness of intrathecal baclofen therapy for the treatment of severe spasticity associated with cerebral palsy. J Child Neurol. 2007;22:49–59.

    Article  PubMed  Google Scholar 

  48. Steinbok P, Daneshvar H, Evans D, Kestle JRW. Cost analysis of continuous intrathecal baclofen versus selective functional posterior rhizotomy in the treatment of spastic quadriplegia associated with cerebral palsy. Pediatr Neurosurg. 1995;22:255–65.

    Article  CAS  PubMed  Google Scholar 

  49. Gooch JL, Oberg WA, Grams B, et al. Care provider assessment of intrathecal baclofen in children. Dev Med Child Neurol. 2004;46:548–52.

    Article  PubMed  Google Scholar 

  50. Campbell WM, Ferrel A, McLaughlin JF, et al. Long-term safety and efficacy of continuous intrathecal baclofen. Dev Med Child Neurol. 2002;44:660–5.

    Article  PubMed  Google Scholar 

  51. Sampson FC, Hayward A, Evans G et al. Functional benefits and cost/benefit analysis of continuous intrathecal baclofen infusion for the management of severe spasticity. J Neurosurg. 2002;96:1052–7.

    Google Scholar 

  52. Albright AL, Barry MJ, Fasick MP, Janosky J. Effects of continuous intrathecal baclofen infusion and selective posterior rhizotomy on upper extremity spasticity. Pediatr Neurosurg. 1995;23:82–5.

    Google Scholar 

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Authors and Affiliations

  1. Division of Neurosurgery, Children’s Hospital of Eastern Ontario (CHEO), University of Ottawa, Ottawa, ON, Canada

    Michael Vassilyadi

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  1. Michael Vassilyadi
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Correspondence to Michael Vassilyadi .

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  1. Division of Paediatric Neurology, Aristotle University of Thessaloniki Division of Paediatric Neurology, Thessaloniki, Greece

    Christos P. Panteliadis

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Vassilyadi, M. (2018). Intrathecal Baclofen Therapy. In: Panteliadis, C. (eds) Cerebral Palsy. Springer, Cham. https://doi.org/10.1007/978-3-319-67858-0_25

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  • DOI: https://doi.org/10.1007/978-3-319-67858-0_25

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-67857-3

  • Online ISBN: 978-3-319-67858-0

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