Intrathecal Baclofen Therapy in Children with Cerebral Palsy

In 90 percent of cerebral palsy (CP) patients, the injury to the brain occurs before or at birth, usually from lack of oxygen to the brain.  The disability can cause slight clumsiness in movement of the hands and walking to complete immobility. 

Cerebral Palsy often includes spasticity (abnormal stiffness and contraction of groups of muscles).  Spasticity can be helpful, but it can also cause loss of range of motion, functional impairments, pain, and deformity.

If your child has cerebral palsy with dysfunctional spasticity, you are probably very aware of the use of medications used to control spasticity.  These include muscle relaxants such as diazepam (Valium), tizanidine (Zanaflex), dantrolene (Dantrium), and lioresal (Baclofen).  When these medications are delivered by mouth, the side effects of sedation and confusion can lead to discontinuation of the medication.

Baclofen Pump
One option is the surgical implantation of a pump that delivers Baclofen directly to the spinal fluid (intrathecal Baclofen therapy or ITB).  When this medication is pumped into the space surrounding the spinal canal, it takes less medication to achieve optimal results and therefore, less unpleasant side effects occur. 

The pump is usually implanted under the skin in the abdomen.  A catheter is threaded into the space surrounding the spinal area.  The pump delivers whatever dose is decided upon.  The pump is replenished with Baclofen via injection into the pump.

Ideal candidates for ITB are children who have failed to tolerate oral meds for spasticity.  ITB is very effective when tolerated.  Complications are frequent and often severe but seem to be related to body size, degree and nature of neurologic impairment, functional status and any other diagnoses complicating the diagnosis of CP. 

Further studies are indicated to determine which children can most benefit from ITB.

For further information: "Intrathecal Baclofen Therapy in Children with Cerebral Palsy: Efficacy and complications," Murphy, N MD; Nicole Irwin, M MD; Hoff, C PhD, Archives of Physical Medicine and Rehabilitation.