CONTINUOUS INTRATHECAL BACLOFEN INFUSION FOR SPASTICITY OF CEREBRAL ORIGIN

Objective.-To determine if continuous intrathecal baclofen infusion (CIBI) would provide continuous relief of spasticity in patients with spasticity of cerebral origin, especially children with cerebral palsy. Design.-Prospective, unblinded trial, before and after CIBI. Setting.-Children's Hospital of Pittsburgh (Pa). Patients.-Thirty-seven patients, 5 to 27 years of age, with spasticity of cerebral origin. Intervention.-Continuous intrathecal baclofen infusion for 3 to 48 months. Main Outcome Measures.-Muscle tone, range of motion, upper extremity timed tasks, activities of daily living (ADLs). Results.-Six and 12 months after CIBI, muscle tone was significantly decreased in the upper (P=.04) and lower (P=.001) extremities. There was a significant relationship between baclofen dosage and muscle tone in the upper (P=.02) and lower (P=.001) extremities. Hamstring motion, upper extremity function, and ADLs were significantly improved in 25 patients who were capable of self-care. Conclusion.-Spasticity of cerebral origin can be effectively treated with CIBI. Because baclofen dosages can be titrated for the desired clinical response, CIBI is particularly useful for patients who need some spasticity to stand and ambulate.