Continuously infused intrathecal baclofen over 12 months for spastic hypertonia in adolescents and adults with cerebral palsy

Objective: To determine if the continuous intrathecal delivery of baclofen will control spastic hypertonia caused by longstanding cerebral palsy (CP). Design: Case series. Setting: Tertiary care outpatient and inpatient rehabi litation center directly attached to a university hospital. Patients: Thirteen CP patients (average age, 25yr; range, 13-43yr) with int ractable spastic hypertonia and quadriparesis (one of whom had predominate diplegia) who had not responded to oral medications including baclofen. Intervention: patients were screened via a bolus injection of baclofen intr athecally. Those who dropped an average of 2 points on their lower extremit y (LE) Ashworth scores were offered computer-controlled pump implantation f or 12 months of continuous delivery of intrathecal baclofen (ITB). Main Outcome Measures: Ashworth rigidity scores, spasm scores, and deep ten don reflex scores were collected for both the upper extremities (UEs) and L Es. Differences over time were assessed via descriptive statistics and Wilc oxon's signed-rank test. Results: After 1 year of continuous ITB treatment, the average LE Ashworth score +/- standard deviation decreased from 3.4 +/- 1.2. to 1.5 +/- 0.7 (p < .0001), spasm score from 1.4 +/- 1.6 to 0.6 +/- 1.2 (p = .1024), and refl ex score from 2.5 +/- 1.2 to 0.7 +/- 1.0 (p < .0001). The average UE Ashwor th score decreased from 3.0 +/- 1.2 to 1.7 +/- 1.0 (p < .0001), spasm score from 1.2 +/- 1.6 to 0.2 +/- 0.6 (p = .0135), and reflex score from 2.3 +/- 0.7 to 0.5 +/- 0.9 (1, < .0001), The average ITB dose required to attain t hese effects at 1 year was 263 +/- 91 mug continuously infused per day. Conclusion: Continuously infused ITB can reduce spastic hypertonia in the U Es and LEs associated with long-standing CP. This reduction in tone will al low more freedom of movement and the potential for improved function.