Intratekal baclofenbehandling ved svaer spastisk tetraplegi og dystoni hos børn og unge

Translated title of the contribution: Intrathecal baclofen in the treatment of severe spastic tetraplegia and dystonia in children and adolescents

Niels Ove Illum, Flemming Juul Hansen, Claudia Fischer, Peter V Uldall, Ole Amtoft Nielsen

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

INTRODUCTION: Continuous intrathecal baclofen has been used over the past years especially in adult patients with spasticity of spinal origin. Children and young adults with severe spasticity and dystonia of cerebral origin are difficult to treat in spite of optimal systemic antispasmotic therapy with baclofen, tizanidine, dantrolene and/or diazepam. Intrathecal baclofen has therefore been applied in a group of young patients.

MATERIAL AND METHODS: Eight children and young adults from East Denmark with spasticity and 12 with dystonia aged 3-18 years (median 10.9 years) were tested, operated and treated with continuous intrathecal baclofen for a period of 2-64 months (median 22.2 months). Registration of efficacy, fillings, adjustments of baclofen and other therapies were performed in an out patient setting since 1995.

RESULTS: Spasticity in lower extremities was reduced from Ashworth score 3.5-4.5 (median 4.2) to Ashworth score 2.5-4.0 (median 2.9; p < 0.001) during infusion with baclofen 5-33 micrograms/kg/24 hours (median 19 micrograms/kg/24 hours). The infusion catheter tip was placed at levels Th1-Th12 (median Th7.5). Peroral baclofen was reduced from an average of 5.0 to 0.44 mg/kg/24 hours, tizanidine from 0.4 to 0.1 mg/kg/24 hours, and dantrolene from 4.0 to 0.4 mg/kg/24 hours. After initial adjustments successively increased dosages of average 0.46 microgram/kg/month were needed to maintain the same level of efficacy. In questionnaires parents or guardians rated less spasticity in lower extremities in 15 out of 19 patients, and less pain in 13 out of 19 patients.

CONCLUSION: Continuous intrathecal baclofen was effective in treating severe spasticity and dystonia of cerebral origin with major effect on muscles of the lower extremities, pelvis, and back and in particular opisthotonus was relieved. Efficacy on upper extremities was far less pronounced.

Original languageDanish
JournalUgeskrift for Laeger
Volume165
Issue number17
Pages (from-to)1755-9
Number of pages5
ISSN0041-5782
Publication statusPublished - 21. Apr 2003

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Quadriplegia
Dantrolene
Social Adjustment
Young Adult
Denmark
Catheters
Parents
Muscles

Cite this

Illum, N. O., Hansen, F. J., Fischer, C., Uldall, P. V., & Nielsen, O. A. (2003). Intratekal baclofenbehandling ved svaer spastisk tetraplegi og dystoni hos børn og unge. Ugeskrift for Laeger, 165(17), 1755-9.
Illum, Niels Ove ; Hansen, Flemming Juul ; Fischer, Claudia ; Uldall, Peter V ; Nielsen, Ole Amtoft. / Intratekal baclofenbehandling ved svaer spastisk tetraplegi og dystoni hos børn og unge. In: Ugeskrift for Laeger. 2003 ; Vol. 165, No. 17. pp. 1755-9.
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abstract = "INTRODUCTION: Continuous intrathecal baclofen has been used over the past years especially in adult patients with spasticity of spinal origin. Children and young adults with severe spasticity and dystonia of cerebral origin are difficult to treat in spite of optimal systemic antispasmotic therapy with baclofen, tizanidine, dantrolene and/or diazepam. Intrathecal baclofen has therefore been applied in a group of young patients.MATERIAL AND METHODS: Eight children and young adults from East Denmark with spasticity and 12 with dystonia aged 3-18 years (median 10.9 years) were tested, operated and treated with continuous intrathecal baclofen for a period of 2-64 months (median 22.2 months). Registration of efficacy, fillings, adjustments of baclofen and other therapies were performed in an out patient setting since 1995.RESULTS: Spasticity in lower extremities was reduced from Ashworth score 3.5-4.5 (median 4.2) to Ashworth score 2.5-4.0 (median 2.9; p < 0.001) during infusion with baclofen 5-33 micrograms/kg/24 hours (median 19 micrograms/kg/24 hours). The infusion catheter tip was placed at levels Th1-Th12 (median Th7.5). Peroral baclofen was reduced from an average of 5.0 to 0.44 mg/kg/24 hours, tizanidine from 0.4 to 0.1 mg/kg/24 hours, and dantrolene from 4.0 to 0.4 mg/kg/24 hours. After initial adjustments successively increased dosages of average 0.46 microgram/kg/month were needed to maintain the same level of efficacy. In questionnaires parents or guardians rated less spasticity in lower extremities in 15 out of 19 patients, and less pain in 13 out of 19 patients.CONCLUSION: Continuous intrathecal baclofen was effective in treating severe spasticity and dystonia of cerebral origin with major effect on muscles of the lower extremities, pelvis, and back and in particular opisthotonus was relieved. Efficacy on upper extremities was far less pronounced.",
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Illum, NO, Hansen, FJ, Fischer, C, Uldall, PV & Nielsen, OA 2003, 'Intratekal baclofenbehandling ved svaer spastisk tetraplegi og dystoni hos børn og unge', Ugeskrift for Laeger, vol. 165, no. 17, pp. 1755-9.

Intratekal baclofenbehandling ved svaer spastisk tetraplegi og dystoni hos børn og unge. / Illum, Niels Ove; Hansen, Flemming Juul; Fischer, Claudia; Uldall, Peter V; Nielsen, Ole Amtoft.

In: Ugeskrift for Laeger, Vol. 165, No. 17, 21.04.2003, p. 1755-9.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Intratekal baclofenbehandling ved svaer spastisk tetraplegi og dystoni hos børn og unge

AU - Illum, Niels Ove

AU - Hansen, Flemming Juul

AU - Fischer, Claudia

AU - Uldall, Peter V

AU - Nielsen, Ole Amtoft

PY - 2003/4/21

Y1 - 2003/4/21

N2 - INTRODUCTION: Continuous intrathecal baclofen has been used over the past years especially in adult patients with spasticity of spinal origin. Children and young adults with severe spasticity and dystonia of cerebral origin are difficult to treat in spite of optimal systemic antispasmotic therapy with baclofen, tizanidine, dantrolene and/or diazepam. Intrathecal baclofen has therefore been applied in a group of young patients.MATERIAL AND METHODS: Eight children and young adults from East Denmark with spasticity and 12 with dystonia aged 3-18 years (median 10.9 years) were tested, operated and treated with continuous intrathecal baclofen for a period of 2-64 months (median 22.2 months). Registration of efficacy, fillings, adjustments of baclofen and other therapies were performed in an out patient setting since 1995.RESULTS: Spasticity in lower extremities was reduced from Ashworth score 3.5-4.5 (median 4.2) to Ashworth score 2.5-4.0 (median 2.9; p < 0.001) during infusion with baclofen 5-33 micrograms/kg/24 hours (median 19 micrograms/kg/24 hours). The infusion catheter tip was placed at levels Th1-Th12 (median Th7.5). Peroral baclofen was reduced from an average of 5.0 to 0.44 mg/kg/24 hours, tizanidine from 0.4 to 0.1 mg/kg/24 hours, and dantrolene from 4.0 to 0.4 mg/kg/24 hours. After initial adjustments successively increased dosages of average 0.46 microgram/kg/month were needed to maintain the same level of efficacy. In questionnaires parents or guardians rated less spasticity in lower extremities in 15 out of 19 patients, and less pain in 13 out of 19 patients.CONCLUSION: Continuous intrathecal baclofen was effective in treating severe spasticity and dystonia of cerebral origin with major effect on muscles of the lower extremities, pelvis, and back and in particular opisthotonus was relieved. Efficacy on upper extremities was far less pronounced.

AB - INTRODUCTION: Continuous intrathecal baclofen has been used over the past years especially in adult patients with spasticity of spinal origin. Children and young adults with severe spasticity and dystonia of cerebral origin are difficult to treat in spite of optimal systemic antispasmotic therapy with baclofen, tizanidine, dantrolene and/or diazepam. Intrathecal baclofen has therefore been applied in a group of young patients.MATERIAL AND METHODS: Eight children and young adults from East Denmark with spasticity and 12 with dystonia aged 3-18 years (median 10.9 years) were tested, operated and treated with continuous intrathecal baclofen for a period of 2-64 months (median 22.2 months). Registration of efficacy, fillings, adjustments of baclofen and other therapies were performed in an out patient setting since 1995.RESULTS: Spasticity in lower extremities was reduced from Ashworth score 3.5-4.5 (median 4.2) to Ashworth score 2.5-4.0 (median 2.9; p < 0.001) during infusion with baclofen 5-33 micrograms/kg/24 hours (median 19 micrograms/kg/24 hours). The infusion catheter tip was placed at levels Th1-Th12 (median Th7.5). Peroral baclofen was reduced from an average of 5.0 to 0.44 mg/kg/24 hours, tizanidine from 0.4 to 0.1 mg/kg/24 hours, and dantrolene from 4.0 to 0.4 mg/kg/24 hours. After initial adjustments successively increased dosages of average 0.46 microgram/kg/month were needed to maintain the same level of efficacy. In questionnaires parents or guardians rated less spasticity in lower extremities in 15 out of 19 patients, and less pain in 13 out of 19 patients.CONCLUSION: Continuous intrathecal baclofen was effective in treating severe spasticity and dystonia of cerebral origin with major effect on muscles of the lower extremities, pelvis, and back and in particular opisthotonus was relieved. Efficacy on upper extremities was far less pronounced.

KW - Adolescent

KW - Baclofen

KW - Child

KW - Child, Preschool

KW - Dystonia

KW - GABA Agonists

KW - Humans

KW - Infusion Pumps

KW - Injections, Spinal

KW - Muscle Relaxants, Central

KW - Muscle Spasticity

KW - Quadriplegia

M3 - Tidsskriftartikel

C2 - 12768902

VL - 165

SP - 1755

EP - 1759

JO - Ugeskrift for Laeger

JF - Ugeskrift for Laeger

SN - 0041-5782

IS - 17

ER -

Illum NO, Hansen FJ, Fischer C, Uldall PV, Nielsen OA. Intratekal baclofenbehandling ved svaer spastisk tetraplegi og dystoni hos børn og unge. Ugeskrift for Laeger. 2003 Apr 21;165(17):1755-9.