CH Ko, PWT Tse, GMS Wong, JCZ Lui, M Leung, J Man

Abstract

Continuous intrathecal baclofen infusion (CIBI) is an effective treatment in patients with severe spinal spasticity. Its use in spastic cerebral palsy (CP) is less well established. In the present study, we aim to evaluate the efficacy and safety of intrathecal baclofen in children with cerebral spasticity. Four nonambulatory children with severe mental retardation were recruited, including two patients with spastic CP and two mixed spastic and dyskinetic CP. Bolus intrathecal baclofen was instillated via an indwelling catheter in the lumbar subarachnoid space, starting at a dose of 25 μg and increased by 25 μg increments 24 hours apart, with a maximum dose of 100 μg. The muscle tone of the upper and lower extremities were recorded by the Ashworth score at 2-hour, 4-hour and 6-hour post-injection. The average Ashworth score of the lower extremities decreased from 2.1 to 1.5. The muscle tone started to decrease within two hours after injection, and remained low throughout the six hour observation period (p<0.05). Three children had their muscle tone reduced to nearly normal (Ashworth scores 1.0 to 1.3). The average muscle tone in the upper extremities was not significantly affected. Apart from mild drowsiness and skin infection, no severe adverse events were encountered. Our preliminary data suggests that intrathecal baclofen is effective in reducing the lower extremity hypertonicity in spastic CP children. Patients with severe spasticity refractory to conventional therapy may benefit from CIBI via subcutaneously placed programmable pumps.