Long-term intrathecal baclofen therapy for severe spasticity of cerebral origin

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Object. The goal of this study was to ascertain the long-term effectiveness and safety of intrathecal baclofen (ITB) in the treatment of spasticity of cerebral origin in children and young adults.

Methods. A prospective, multicenter study was conducted in 68 patients who had been enrolled in the initial evaluation of ITB therapy and were willing to participate in long-term surveillance. Seventy-three percent of the patients were younger than 16 years of age at the time of study entry. The patients were examined at least every 3 months and were observed for an average of 70 months. At each follow-up visit, spasticity in the upper and lower extremities was evaluated by applying Ashworth scores. All adverse events and complications were recorded on standardized data forms.

Spasticity in both upper and lower extremities decreased significantly (p < 0.005) and remained decreased up to 10 years. The dosage of ITB increased from a mean of 157 (µg/day 3 months after pump insertion to 300 (µg/day at 2 years postimplantation, and remained relatively stable thereafter. There were no significant differences in ITB dosage in children of different ages. Adverse events potentially related to ITB therapy occurred in 50% of patients within 2 months after pump insertion and in 50% of patients thereafter; hypotonia and lethargy were the two most common adverse events. The most common complications of surgery were catheter-related problems (31%), seromas (24%), and cerebrospinal fluid leaks (15%).

Conclusions. Intrathecal baclofen provides effective long-term treatment of spasticity of cerebral origin and its effects do not appear to diminish with time. This therapy is frequently associated with adverse side effects that usually can be alleviated by adjustments in dosage.

Article Information

Address reprint requests to: A. Leland Albright, M.D., Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, Pennsylvania 15213. email: Leland.Albright@chp.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Graph demonstrating mean Ashworth scores in the upper extremities at 6-month intervals after pump implantation. The scores were significantly decreased at 1 and 2 years postimplantation (p < 0.005). S.E. = standard error.

  • View in gallery

    Graph demonstrating mean Ashworth scores in the lower extremities at 6-month intervals after pump implantation. The scores were significantly decreased postimplantation at 1 and 2 years (p < 0.005).

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    Graph showing the mean daily dosage of ITB in micrograms at different follow-up times. Dosages increased during the first 2 years and remained relatively constant thereafter.

  • View in gallery

    Graph showing mean daily ITB doses in micrograms at yearly intervals in children younger than 12 years of age (diamonds), 12 to 15 years (squares), and 16 years of age and older (triangles). There were no significant differences in dosages among the three age groups.

References

1.

Albright ALBarron WBFasick MPet al: Continuous intrathecal baclofen infusion for spasticity of cerebral origin. JAMA 270:247524771993Albright AL Barron WB Fasick MP et al: Continuous intrathecal baclofen infusion for spasticity of cerebral origin. JAMA 270:2475–2477 1993

2.

Albright ALBarry MJFasick MPet al: Effects of continuous intrathecal baclofen infusion and selective posterior rhizotomy on upper extremity spasticity. Pediatr Neurosurg 23:82851995Albright AL Barry MJ Fasick MP et al: Effects of continuous intrathecal baclofen infusion and selective posterior rhizotomy on upper extremity spasticity. Pediatr Neurosurg 23:82–85 1995

3.

Albright ALCervi ASingletary J: Intrathecal baclofen for spasticity in cerebral palsy. JAMA 265:141814221991Albright AL Cervi A Singletary J: Intrathecal baclofen for spasticity in cerebral palsy. JAMA 265:1418–1422 1991

4.

Armstrong RWSteinbok PCochrane DDet al: Intrathecally administered baclofen for treatment of children with spasticity of cerebral origin. J Neurosurg 87:4094141997Armstrong RW Steinbok P Cochrane DD et al: Intrathecally administered baclofen for treatment of children with spasticity of cerebral origin. J Neurosurg 87:409–414 1997

5.

Ashworth B: Preliminary trial of carisoprodol in multiple sclerosis. Practitioner 192:5405421964Ashworth B: Preliminary trial of carisoprodol in multiple sclerosis. Practitioner 192:540–542 1964

6.

Butler CCampbell S: Evidence of the effects of intrathecal baclofen for spastic and dystonic cerebral palsy. Dev Med Child Neurol 42:6346452000Butler C Campbell S: Evidence of the effects of intrathecal baclofen for spastic and dystonic cerebral palsy. Dev Med Child Neurol 42:634–645 2000

7.

Campbell SKAlmeida GLPenn RDet al: The effects of intrathecally administered baclofen on function in patients with spasticity. Phys Ther 75:3523621995Campbell SK Almeida GL Penn RD et al: The effects of intrathecally administered baclofen on function in patients with spasticity. Phys Ther 75:352–362 1995

8.

Gilmartin RBruce DStorrs BBet al: Intrathecal baclofen for management of spastic cerebral palsy: multicenter trial. J Child Neurol 15:71772000Gilmartin R Bruce D Storrs BB et al: Intrathecal baclofen for management of spastic cerebral palsy: multicenter trial. J Child Neurol 15:71–77 2000

9.

Grabb PAGuin-Renfroe SMeythaler JM: Midthoracic catheter tip placement for intrathecal baclofen administration in children with quadriparetic spasticity. Neurosurgery 45:8338371999Grabb PA Guin-Renfroe S Meythaler JM: Midthoracic catheter tip placement for intrathecal baclofen administration in children with quadriparetic spasticity. Neurosurgery 45:833–837 1999

10.

Kroin JSAli AYork Met al: The distribution of medication along the spinal canal after chronic intrathecal administration. Neurosurgery 33:2262301993Kroin JS Ali A York M et al: The distribution of medication along the spinal canal after chronic intrathecal administration. Neurosurgery 33:226–230 1993

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