Long-term intrathecal baclofen therapy for severe spasticity of cerebral origin.
OBJECTIVE
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 microg/day 3 months after pump insertion to 300 microg/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.
Albright
A Leland
AL
Department of Pediatric Neurosurgery, Children's Hospital of Pittsburgh, Pennsylvania 15213, USA. Leland.Albright@chp.edu
Gilmartin
Richard
R
Swift
Dale
D
Krach
Linda E
LE
Ivanhoe
Cindy B
CB
McLaughlin
John F
JF
D000293:Adolescent; D001418:Baclofen / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D001927:Brain Diseases / Q000150:complications*; D002540:Cerebral Cortex / Q000187:drug effects*; D002648:Child; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D006801:Humans; D007278:Injections, Spinal; D009125:Muscle Relaxants, Central / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology*; D018482:Muscle, Skeletal / Q000187:drug effects; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
D009125:Muscle Relaxants, Central; D001418:Baclofen