Complications of intrathecal baclofen pumps in children.
Intrathecal baclofen is increasingly being used to manage severe spasticity in children. Although substantial tone reduction with this treatment has been documented, complications also occur. In this study, we describe the device- and major non-device-related complications in a group of 100 consecutive children and young adults who received 117 intrathecal baclofen pumps for the management of severe spasticity. Twenty-four patients (24%) experienced a total of 48 complications. The most common complication was disconnection of the catheter at its connection to the pump, occurring in 9% of pumps implanted. This complication occurred more frequently in pumps with catheter access ports (16%) than in those without ports (2%). Catheter dislodgement from the intrathecal space was the next most common complication, occurring in 8% of pumps implanted (13% of pumps with ports, 4% of pumps without ports). To decrease the occurrence of the most common complications of intrathecal pumps, we now typically implant pumps without catheter access ports, and we use 2-piece catheters. Although the lack of an access port may be a disadvantage for troubleshooting, most complications can be detected in pumps without a port. Patient and family education is critical in preventing serious consequences of baclofen withdrawal resulting from catheter-related complications.
Gooch
Judith L
JL
Primary Children's Medical Center, Salt Lake City, Utah 84113, USA. pcjgooch@ihc.com
Oberg
Wende A
WA
Grams
Barbara
B
Ward
Lorrie A
LA
Walker
Marion L
ML
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001418:Baclofen / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D004867:Equipment Design; D004868:Equipment Failure; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007263:Infusions, Parenteral / Q000009:adverse effects; D009125:Muscle Relaxants, Central / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D009128:Muscle Spasticity / Q000188:drug therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
D009125:Muscle Relaxants, Central; D001418:Baclofen