ABSTRACT
OBJECT: The authors investigated the efficacy of intrathecal baclofen therapy, analyzing the complications and risk factors in 200 consecutive patients who received pump implants. METHODS: The patient population included 200 patients (mean age 13.7 +/- 5.68 years). The follow-up duration varied from 13.07 to 87.50 months (mean 50.71 months). RESULTS: The mean Ashworth Scale, Barry-Albright Dystonia Scale, clonus, and spasm scores decreased postoperatively. Overall, 31% of patients experienced complications as follows: 11% had cerebrospinal fluid leakage, 7% had catheter-related problems, 7.5% suffered infections; 5.5% of patients had more than one complication. CONCLUSIONS: The authors found that the onset of at least one complication is statistically more likely in patients with Ashworth Scale scores higher than 3 and an age of 10 years or younger. A reduction in the incidence of infection from 10 to 4.8% by the end of the study period appears to be correlated with the switch in technique to subfascial instead of subcutaneous pump implantation and the adoption of a new preoperative prophylaxis protocol in the last 51 patients. There were no statistically significant correlations between the onset of complications and patient weight, ambulatory status, or the presence of dystonia or cerebral palsy.
Subject(s)
Baclofen/administration & dosage , Cerebral Palsy/drug therapy , Infusion Pumps, Implantable , Muscle Relaxants, Central/administration & dosage , Spinal Cord/drug effects , Adolescent , Baclofen/adverse effects , Child , Child, Preschool , Female , Humans , Injections, Spinal , Italy , Male , Muscle Relaxants, Central/adverse effects , Muscle Spasticity/drug therapy , Outcome and Process Assessment, Health Care , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Retrospective Studies , Treatment OutcomeABSTRACT
The objective of this study was to analyze the relationship between epilepsy and intrathecal baclofen by investigating a consecutive sample of 150 children with cerebral palsy or spasticity of cerebral origin who underwent intrathecal baclofen. The medical charts of the 150 children were retrospectively reviewed. A series of 100 children with cerebral palsy, operated on other procedures, was reviewed as a control group. Forty percent of the 150 children had epilepsy before intrathecal baclofen pump implantation; 13.3% had a decrease in seizure frequency after intrathecal baclofen, while two children worsened and one child had seizures ex novo. We conclude that in children with spasticity of cerebral origin, intrathecal baclofen does not seem to aggravate or induce seizure activity.
