Affiliations: Department of Orthopaedic Surgery, Wake Forest
University School of Medicine, Winston-Salem, NC, USA
Note: [] Address for correspondence: Jeffrey S. Shilt, MD, Associate
Professor, Department of Orthopaedic Surgery, Wake Forest University School of
Medicine, Medical Center Blvd., Winston-Salem, NC 27157, USA. Tel.: +1 336 716
3949; Fax: +1 336 716 6286; E-mail: jshilt@aol.com
Abstract: Spasticity, a common symptom accompanying cerebral palsy (CP), can
severely affect patients' function and cause disability in childhood.
Intrathecal baclofen (ITB) therapy is a widely used treatment to reduce
spasticity in quadriparetic CP patients. Likewise, adults sustaining strokes
and subsequent spastic hemiplegic have proven excellent candidates as well from
ITB therapy. However, data on ITB treatment in pediatric patients with
hemiplegic CP are lacking. This is the first report to present such a case. A
nine-year old girl with spastic hemiplegic CP failed chemical denervation and
serial casting of lower extremity spasticity and an associated equinovarus
contracture. An ITB bolus test revealed an improvement in her Ashworth score
from a mean of 2.8 to 1.2 on the involved side, whereas the unaffected side
stayed constant from a mean of 1.3 to 1.2. The patient was subsequently treated
with continuous ITB with improvement of Ashworth scores from a mean of 2.8 at
baseline to 1.1 at 17 months after implantation of the ITB pump. Subsequent
surgery was performed to correct the residual ankle deformity resulting in
improvements in passive range of motion, gait function and brace tolerance.
Hemiplegic CP pediatric patients can be successfully treated with ITB to reduce
spasticity, improve function, and retain postoperative surgical correction
without affecting the normal side.
