Intrathecal baclofen therapy for treatment of spasticity in infants and small children under 6 years of age
The aim of this study is to prove the efficacy and safety of intrathecal baclofen therapy in infants and children below 6 years of age by retrospective analysis of our pediatric cohort of 135 primary pump implantations.
Between 2007 and 2018, 17 patients with pump implantations were below 6 years of age. Data were acquired retrospectively with a follow-up of 12 months to 11 years regarding complications.
The youngest infant was 11 months at implantation with a bodyweight of 6, 4 kg, and 63 cm length. Surgical complications were comparable to published literature and mainly involved the catheter (2 catheter dislocations and 1 catheter transection) and one pump infection resulting in 4 revision surgeries in 3 patients. One baclofen-related apnea during titration and an overdose after refill were treated conservatively. Using a subfascial implantation technique, we observed neither skin ulceration nor pump infection since 2007. In a growing child, catheter slides are common and related to growth, scoliosis, spine surgery, and surgical failure.
Intrathecal baclofen therapy in infants and small children is as safe and effective as published for older pediatric patients; therefore, intrathecal baclofen can be considered in all infants as long as an 8-cm incision fits into the triangle of the anterior superior iliac spine, costal margin of the 10th rib, and navel. We suggest the utilization of subfascial surgical technique for implantation pump and catheter. Titration of intrathecal baclofen should be performed slowly to avoid bradycardia in infants. This is a retrospective study (level of evidence 4).
KeywordsIntrathecal baclofen therapy Baclofen pump implantation Infants Spasticity Cerebral palsy Dystonia Children Pediatrics
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 13.Kopell BH, Sala D, Doyle WK, Feldman DS, Wisoff JH, Weiner HL (2001) Subfascial implantation of intrathecal baclofen pumps in children: technical note. Neurosurgery. 49(3):753–756 discussion 756-7Google Scholar
- 14.Chan DY, Chan SS, Chan EK, Ng AY, Ying AC, Li AC, Chiu CC, Cheung N, Mak WK, Sun DT, Zhu CX, Poon WS (2018) Blessing or burden? Long-term maintenance, complications and clinical outcome of intrathecal baclofen pumps. Surg Pract 22(3):105–110. https://doi.org/10.1111/1744-1633.12308 CrossRefGoogle Scholar
- 17.Ghobrial GM, Thakkar V, Singhal S, Oppenlander ME, Maulucci CM, Harrop JS, Jallo J, Prasad S, Saulino M, Sharan AD (2014) Efficacy of intraoperative vancomycin powder use in intrathecal baclofen pump implantation procedures: single institutional series in a high risk population. J Clin Neurosci 21(10):1786–1789. https://doi.org/10.1016/j.jocn.2014.04.007 CrossRefGoogle Scholar