ABSTRACT
PURPOSE: Intrathecal baclofen administration is commonly used in the treatment of children's spasticity. In general, candidates for baclofen pump are patients with spastic form of cerebral palsy. Intrathecal baclofen in the treatment of spasticity due to a metabolic disorder is rarely reported. METHODS: Authors report on an 11-year-old boy with mucopolysaccharidosis type II (Hunter syndrome) with progressive stiffness and contractures followed by profound loss of joint movement range and tiptoe walking pattern. Patient was indicated for baclofen test with subsequent pump insertion and continuous intrathecal baclofen administration. RESULTS: Postoperatively, patient was gradually set to current baclofen dose of 250 µg/day. At mentioned dose, we observed not only increased active and passive range of movements and facilitation in fine motor skills, but also better walking pattern. CONCLUSIONS: Despite intrathecal baclofen administration in patients with spasticity related to mucopolysaccharidosis type II is not widely reported, we consider it as feasible treatment. To emphasize, enzyme replacement therapy is the primary treatment, and improvement is attributed to both enzyme substitution and intrathecal baclofen therapy.
Subject(s)
Baclofen/administration & dosage , Mucopolysaccharidosis II/drug therapy , Muscle Relaxants, Central/administration & dosage , Child , Humans , Infusion Pumps, Implantable , Injections, Spinal , Male , Mucopolysaccharidosis II/complications , Muscle Spasticity/drug therapy , Muscle Spasticity/etiologyABSTRACT
BACKGROUND: Though the foramen magnum (FM) is often altered in complex craniosynostosis, no study analysed the FM dimensions in patients with brachycephaly specifically. PATIENTS AND METHODS: We measured the FM area, sagittal and transverse diameters on preoperative CT scans in patients with bicoronal synostosis (n = 40) and age-matched control group (n = 18). Our study included 16 children with FGFR3 p.Pro250Arg mutation (mean age 6.1 months), 10 with TWIST-1 mutation (mean age7.6 months) and 14 patients with isolated bicoronal synostosis (mean age 6.1). RESULTS: We observed a significantly smaller FM area in FGFR3 group compared to control group and isolated brachycephaly group (p = 0.001 and p = 0.038, respectively). The mean FM area in FGFR3 group was 426.13 mm(2) (p = 0.001), while in TWIST-1 group was 476.34 mm(2) (p = 0.103), and in isolated brachycephaly group 489.43 mm(2) (p = 0.129) compared to control group: 528.90 mm(2). The posterior segment of the sagittal diameter of the FM and its width as well as the bi-interoccipital synchondrosis diameters were significantly smaller in FGFR3 group compared to control group. In TWIST-1 group, the only altered dimension was the FM anterior segment of the sagittal diameter (p = 0.008). We did not observe any significant alteration of FM in patients with isolated brachycephaly compared to control group. DISCUSSION AND CONCLUSIONS: The FM area is significantly altered in FGFR3-related brachycephaly, whereas in patients with Saethre-Chotzen syndrome (TWIST-1 mutation) the mean FM area is similar to control group. This study confirms the importance of FGFRs on FM growth whereas TWIST-1 seems to have a minor role.
