Affiliations: Department of Orthopaedic Surgery, Wake Forest
University School of Medicine, Winston-Salem, NC, USA | Upstate Medical University, Syracuse, NY, USA
Note: [] Address for correspondence: Kat Kolaski, MD, Assistant
Professor, Department of Orthopaedic Surgery, Wake Forest University School of
Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA. E-mail:
kkolaski@wfubmc.edu
Abstract: Continuous intrathecal baclofen (CITB) is considered a standard
treatment for spasticity in patients with cerebral palsy (CP). This review
summarizes the recent literature and assesses the evidence for the efficacy of
ITB for spasticity and its related sequelae in patients with CP. The literature
was searched using electronic databases and reference lists from March 2000
through April 2007. Studies included report treatment effects of ITB in
patients with CP. The outcomes reported in the 29 studies identified are
classified using the International Classification of Functioning, Disability
and Health model. The studies are graded for their level and, when appropriate,
quality of evidence. The majority of the studies are case series which receive
a Level IV grade of evidence. One study provides Level II evidence for the
reduction of spasticity after administration of a bolus test dose of ITB as
documented by changes in neurophysiologic reflexes. Longer term studies support
the effectiveness of CITB for maintenance of muscle tone reduction as
documented by clinical scales. Multiple studies suggest a linkage of CITB with
improvements in function, ease of care, and quality of life. The evidence for
improvements in dystonia and musculoskeletal problems is equivocal. Limitations
of the research in this area and recommendations for improving its quality are
discussed.
