Article

AIM: To measure changes in children with severe spastic cerebral palsy (CP) after
continuous intrathecal baclofen (ITB) infusion over 18 months and to compare the
results with those of a comparison group awaiting treatment. METHOD: Thirty-eight
children with severe spastic CP considered suitable for ITB were assessed when
first seen, just before insertion of an intrathecal pump, and 9 months and 18
months later. Eighteen children waited around 9 months for a pump (group 1: nine
males, nine females; mean age 9y 11mo [SD 3y 7mo], nine in Gross Motor Function
Classification System [GMFCS] level IV, nine in level V). This baseline period
was used as a control for comparison with the first and second 9-month periods
after the pump for the remaining 20 children (group 2: 11 males, nine females;
mean age 10y 2mo [SD 3y 1mo], nine in GMFCS level IV, 11 in level V). The main
outcome measure was the Pediatric Evaluation of Disability Inventory (PEDI);
other assessments were of function, ease of care, quality of life, and costs of
new equipment. RESULTS: No significant change was found in the PEDI between group
1 while awaiting treatment and group 2 in the two periods afterwards, nor in the
Lifestyle Assessment Questionnaire or the cost of new equipment. Significant
changes were found in group 2 in the first 9 months according to the modified
Ashworth score (difference between mean values for groups -1.7, standard error
0.58; p=0.008), Penn Spasm score (-1.3, 0.37; p=0.001), mean joint range of
movement (8.3 degrees , 2.8; p=0.005), and Caregiver Questionnaire (-19.7, 5.1;
p=0.01), and in the second 9 months for the Modified Ashworth Scale score (-0.62,
0.12; p=0.001). INTERPRETATION: ITB in children with severe spastic CP over the
first 18 months improves their quality of life in terms of comfort and ease of
care. It has less effect on function, participation in society, or the overall
cost of new equipment.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2011 Mac Keith
Press.

Langue : ANGLAIS