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Title: Effects of intrathecal baclofen therapy in children with severe spasticity

Abstract:

INTRODUCTIONAn unsuccessful conservative treatment (pharmacological treatment; physical therapy) of severe spasticity is an indication for intrathecal baclofen therapy (ITB).The intrathecal delivery of baclofen has been show to be effective tool in the treatment of spasticty in children with cerebral palsy (CP) and in spinal cord injuries (SCI). There are few works about good results in treatment of dystonia with ITB. Baclofen, an analog of the inhibitory neurotransmiter GABA, bins to presynaptic GABA-B receptors in the brain stem, dorsal horn of the spinal cord, and other central nervous system (CNS) sites. Baclofen delivered intrathecally by a pump inserted subfascially and connected with the thecal sac by the catheter, gets directly to the cerebrospinal fluid, so that dosages can be about 100-fold lower than the oral dose. The positive responsivenes to ITB in the screening test is the direct indication to baclofen pump implantation. In patients who do not respond to baclofen test, may be present established contractures, and this is a contraindication to ITB.Intrathecally delivered baclofen is a chance for improvement in quality of life, easy of care and physical therapy or even functional abilities.OBJECTIVES: To evaluate results of intrathecal baclofen therapy in children with severe spasticity.MATERIAL AND METHODS: There are 34 patients (aged range 4-19 years; mean 12,9) with generalized, severe spasticity, involved to receive baclofen pump.Outcome measure included the Modified Ashworth Scale (MAS), the inability Rankin Index, functional status with Barthel Index and spasms frequency with Penn Scale. Additionally, to obtain caregiver expectations and opinions about changes in their assistance in activity daily living (ADL), as well as satisfaction with ITB.RESULTS:There was stastitically significant improvement in the decrease of spasticity, both in the lower and upper extremities, compared to the baseline assessment.The analysis of functional abilities assessed with the Barthel Index show statistically significant improvement in area of transfer from bed to wheelchair, in mobility on flat surface, going upstairs and downstairs and in dressing.Improvement was noted in the inabiliti status measured with Rankin Index. There was statistically significant decline in spasms frequency assessed with Penn Scale. Caregivers asses ITB as an effective treatment of spasticity especially due to facilitation of easy of care, rehabilitation, an improvement of quality of sleep and decrease of pain. There was no improvement in the self-care of patients.CONCLUSIONS: ntrathecal baclofen therapy is an effective metod in the treatment of severe spasticity. Positive results of ITB can be achieved on conditon a carefull selection of patients, clear information for caregivers, setting a reasonable treatment golas and constant physical therapy.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

neurologia ; rehabilitacja ; pediatria

Degree grantor:

Uniwersytet Jagielloński. Collegium Medicum. Wydział Lekarski.

Promoter:

Stanisław Kwiatkowski

Date issued:

2011

Format:

application/pdf

Identifier:

oai:dl.cm-uj.krakow.pl:3410

Call number:

ZB-116236

ControlNumberVIRTUA:

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Language:

pol

Access rights:

tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum

Object collections:

Last modified:

Oct 17, 2019

In our library since:

Mar 5, 2013

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12

Number of object content views in PDF format

12

All available object's versions:

http://dl.cm-uj.krakow.pl:8080/publication/3410

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ZB-116236 Oct 17, 2019
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