Continuous intrathecal baclofen for children with spasticity and/or dystonia: Goal attainment and complications associated with treatment.
OBJECTIVE
To describe complications and outcomes of intrathecal baclofen (ITB) therapy in children with spasticity and/or dystonia.


METHODS
A prospective study of goal attainment after ITB therapy and a retrospective review of medical records for complications. The children were described as dystonia-predominant or spasticity-predominant and the subgroups were compared. Goals were assessed at baseline and goal attainment at 6 months post-implant. Data were analysed using Wilcoxon signed-rank test. The patients' goals were measured with the Canadian Occupational Performance Measure (COPM) and goal attainment scaling (GAS). Complication rates were calculated by dividing the number of complications by the duration of pump implantation.


RESULTS
Twenty-five children were included, 16 with complete goal attainment data. The mean age was 10 years and 3 months. Eighty-eight percent had a diagnosis of cerebral palsy. The most common goals were improved positioning and transfers. A statistically significant increase (P < 0.001) in both domains of the COPM was demonstrated. The mean GAS T-score was significantly higher at 6 months post implant (P < 0.001). Seventy percent of the subjects achieved their goals at 6 months. The complication rate was 0.38 per year of pump operation, higher in subjects with dystonia (0.71) compared with those with spasticity (0.25).


CONCLUSIONS
ITB results in statistically significant levels of satisfaction and goal attainment in children with spasticity and/or dystonia. GAS was a useful measure of goal attainment. While, ITB is effective for children with spasticity and dystonia, those with dystonia have a higher rate of complications.
Ward
Anna
A
Rehabilitation Department, The Children's Hospital at Westmead, Burwood, NSW, Australia. annab2@chw.edu.au <annab2@chw.edu.au>
Hayden
Suzie
S
Dexter
Mark
M
Scheinberg
Adam
A
D000293:Adolescent; D001418:Baclofen / Q000008:administration & dosage* / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004421:Dystonia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008485:Medical Audit; D009128:Muscle Spasticity / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
D001418:Baclofen