Article

Studies on the use of intrathecal baclofen (ITB) for ambulant adults with
spasticity and/or dystonia of cerebral origin are scarce, and are even more
limited for children and adolescents. This systematic review investigates the use
of ITB to improve walking, transfer ability, and gross motor activities in
ambulant children and adolescents with spasticity and/or dystonia of cerebral
origin. METHOD: Electronic databases (MEDLINE, CINAHL, PsycINFO, EMBASE, full
Cochrane Library, and PEDro) were searched from the earliest date available until
March 2011 using combined subject headings and free text if supported by the
databases. Studies were included if they had examined individuals who: (1)
received ITB therapy by any method (bolus injection, an external delivery system,
or an implanted pump); (2) had spasticity and/or dystonia of cerebral origin; (3)
were able to ambulate with or without a walking device, i.e. individuals with
cerebral palsy (CP) who were in levels I to III of the Gross Motor Function
Classification System or individuals with similar functional mobility if they did
not have CP; and (4) were aged 18 years or under. Publications in English in
peer-reviewed journals reporting any type of research design, except reviews and
expert opinions, were included. Studies were excluded if participants had
spasticity and/or dystonia of spinal origin and if baclofen was administered only
orally. Studies that compared ITB with other interventions such as botulinum
toxin were also excluded. RESULTS: Two independent reviewers scored 16 studies
against the guidelines for developing systematic reviews from the American
Academy of Cerebral Palsy and Developmental Medicine (AACPDM). INTERPRETATION:
Fifteen studies were of levels IV or V evidence and only one of level II
according to the evidence levels of the AACPDM guidelines, but all were of low
quality. No study was found on the use of ITB in ambulant children or adolescents
with dystonia of cerebral origin. Not all studies used objective outcome measures
to assess the ambulation, transfer ability, and gross motor activities of the
participants. A proportion of participants showed improvement in all these areas
but adverse events were common. A proportion of participants compromised their
ambulatory and transfer abilities after ITB. There was no evidence to support the
clinical use of ITB in ambulant individuals with hypertonicity without further
rigorous longitudinal studies.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2011 Mac Keith
Press.

Langue : ANGLAIS