title: Intrathecal baclofen therapy in children with cerebral palsy: efficacy and complications.
abstract: OBJECTIVE
  To describe the efficacy of intrathecal baclofen (ITB) therapy in the management of spasticity in young children with cerebral palsy (CP) and to identify risk factors for complications.
  
  
  METHODS
  Consecutive case series of 25 implanted ITB delivery systems during a 48-month period.
  
  
  METHODS
  Pediatric specialty hospital and outpatient department.
  
  
  METHODS
  Twenty-three children (age range, 4.5-17.4y) with CP (spastic diplegia in 22%; spastic quadriplegia in 61%; mixed-type diplegia in 4%; mixed-type quadriplegia in 13%).
  
  
  METHODS
  Intrathecal baclofen therapy in children with cerebral palsy.
  
  
  METHODS
  Ashworth Scale scores before treatment and at 6 and 12 months after ITB therapy; frequency and nature of complications; and relation between patient characteristics and outcomes.
  
  
  RESULTS
  Average Ashworth scores +/- standard deviation decreased from 3.26+/-.73 to 2.34+/-.83 (P<or=.01) in the lower extremities and from 2.69+/-.79 to 2.00+/-.55 (P<or=.05) in the upper extremities 6 months after ITB therapy and remained comparably decreased at 12 months. Explantation was required in 44% (11/25), with wound complications as the leading cause in 73% (8/11). Complications were associated with the diagnosis of mixed-type CP, as compared with pure spastic types (P<or=.01). Trends suggest that children of smaller size and younger age, as well as those with gastrostomy tubes and nonambulatory status, were more likely to encounter complications necessitating explantation.
  
  
  CONCLUSIONS
  ITB therapy effectively reduced spasticity in children with CP. However, complications necessitating explantation can occur. Further research is needed to identify criteria describing the ideal pediatric candidate for ITB.
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, UT 84132, USA. Nancy.Murphy@hsc.utah.edu
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Murphy
authors.forename: Melanie C Nicole
authors.initials: MC
authors.lastname: Irwin
authors.forename: Charles
authors.initials: C
authors.lastname: Hoff
mesh_terms: D000293:Adolescent; D001418:Baclofen / Q000008:administration & dosage / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000145:classification / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007278:Injections, Spinal / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen