Intrathecal injection of baclofen (ITB) improves dystonia, muscle tone, pain, and other impairments in patients with dyskinetic cerebral palsy (CP), a new study from Sweden shows.
The study, “Intrathecal baclofen in dyskinetic cerebral palsy: effects on function and activity,” was published in the journal Developmental Medicine & Child Neurology. It was led by researchers at Queen Silvia Children’s Hospital, in Gothenburg, Sweden, and the University of Gothenburg.
Patients with dyskinetic CP typically have involuntary and uncontrolled movement. Dystonia, or repetitive and involuntary muscle contractions, and choreoathetosis, also involuntary movements, are the main elements of movement disorders.
Children with dyskinetic CP also show significant muscle spasms and severe motor impairment, which is often associated with intellectual impairment and epilepsy. Communication is also severely limited. Effective medical treatment is crucial to facilitate communication in these patients.
Baclofen, a gamma-aminobutyric acid agonist, is a cost-effective muscle relaxer that also treats muscle spasms. Oral and intrathecal — delivered via a pump directly into the spinal fluid — baclofen decreases dystonia, spasms, and pain in children with CP. However, most available literature on ITB use in children has focused solely on its effects on spasms.
Now, researchers analyzed the effect of ITB on function and activity in children and adolescents with dyskinetic CP.
The research team studied medical records from 25 children (15 boys and 10 girls) with a mean age of 10 years and 11 months. Five were classified at Gross Motor Function Classification level IV and 20 at level V. (A higher level corresponds to more severe limitations.) All participants had dystonia before ITB treatment. Pain and disturbed sleep were also reported.
Researchers interviewed the children’s parents about daily activities, sitting, communication, pain, sleep, and gross and fine motor function. Differences before, and one year after, ITB were classified as positive, no change, or negative.
Evaluations of dystonia and muscle tone were conducted with standard scales. Joint range of motion (ROM) also was determined.
Results showed that ITB significantly decreased dystonia and muscle tone. No change was detected in ROM, which could be a positive result as this measurement is expected to worsen in CP, the authors observed.
Parents reported improvements in daily life activities, sitting, and fine motor function. No change was observed in gross motor function.
Communication also was improved, including better control of eye and neck movements, and more variation in voicing.
“An explanation for this improvement may be that reduced muscle tone and decreased frequency and amplitude of involuntary movements/postures made it possible to use arms, head, and voice in a voluntary way and for a meaningful purpose, such as communication,” the researchers wrote.
Furthermore, ITB also reduced pain and sleep disturbances.
Importantly, the overall improvements in these patients helped reduce caregiver burden.
“Following ITB in children and young people with dyskinetic CP, improvements were found in activities such as sitting, communication and fine motor activities. There was a reduction of dystonia and muscle tone, as well as pain and disturbed sleep, making daily care easier,” the team concluded.
The study has limitations, including its small patient size and a lack of a comparison group, which could limit the interpretation of results. More studies are needed to validate the results, researchers acknowledged.
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