Get access

Continuous intrathecal baclofen for children with spasticity and/or dystonia: Goal attainment and complications associated with treatment

Authors

  • Anna Ward,

    Corresponding author
    1. Disability Specialist Unit and the Rehabilitation Department,
      Dr Anna Ward, Disability Specialist Unit, The Children's Hospital at Westmead, PO Box 78, Burwood, NSW 1805, Australia. Fax: +61 02 9701 6350; email: annab2@chw.edu.au
    Search for more papers by this author
  • Suzie Hayden,

    1. Physiotherapy Department, Liverpool Hospital, Liverpool, Sydney, New South Wales and
    Search for more papers by this author
  • Mark Dexter,

    1. Neurosurgery Department, and
    2. Westmead Private Hospital, Westmead,
    Search for more papers by this author
  • Adam Scheinberg

    1. The Rehabilitation Department, The Children's Hospital at Westmead,
    2. The Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Parkville, Victoria, Australia
    Search for more papers by this author

Dr Anna Ward, Disability Specialist Unit, The Children's Hospital at Westmead, PO Box 78, Burwood, NSW 1805, Australia. Fax: +61 02 9701 6350; email: annab2@chw.edu.au

Abstract

Aim:  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.

Get access to the full text of this article

Ancillary