Experience with external pump trial prior to implantation for intrathecal baclofen in ambulatory patients with spastic cerebral palsy.
OBJECTIVE
To evaluate effectiveness and safety of intrathecal baclofen administration (ITB) testing with continuous infusion via an external pump before the implantation of an internal one in ambulatory spastic patients with cerebral palsy (CP).


METHODS
Seven CP patients (3 diplegic, 4 quadriplegic - 18.4+/-7.0 years) with a progressive decrease in walking ability were included. Assessments included: Ashworth's scale, Observational Gait Scale (OGS), and GMFM-66.


RESULTS
During the ITB test (45-150 microg/24h), spasticity decreased by more than two points on Ashworth's scale (p<0.001) and walking ability improved (median OGS increased from 7 to 9, p<or=0.05). After implantation of an internal Synchromed pump (dosage 66-160 microg/24h), mean GMFM-66 increased from 49.9+/-7.3 to 54.5+/-7.7 (p<0.05) and median OGS from 7 to 10 (p<0.05). Two nonambulatory patients recovered some walking ability following implantation of the pump. Adverse effects included one case of chemical meningitis during the test and two temporary CSF leaks.


CONCLUSIONS
Tests of ITB using a continuous infusion by an external pump allowed precise evaluation of the effects of different ITB doses on walking ability, enabling prediction of how the patient would respond to an internal pump. All patients showed ambulatory improvement with ITB.
Bleyenheuft
C
C
Department of Physical Medicine and Rehabilitation, cliniques universitaires Saint-Luc, université catholique de Louvain, B-1200 Brussels, Belgium.
Filipetti
P
P
Caldas
C
C
Lejeune
T
T
D000293:Adolescent; D000328:Adult; D001418:Baclofen / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002404:Catheterization / Q000009:adverse effects; D002547:Cerebral Palsy / Q000150:complications / Q000188:drug therapy*; D002648:Child; D004343:Drug Implants; D005260:Female; D005684:Gait; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008582:Meningitis, Aseptic / Q000139:chemically induced; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D013116:Spinal Cord
D004343:Drug Implants; D009125:Muscle Relaxants, Central; D001418:Baclofen