Upper limb function after intrathecal baclofen therapy in children affected by secondary dystonia .

Upper limb function after intrathecal baclofen therapy in children affected by secondary dystonia .
Paediatric Orthopaedics, “V.Buzzi” Children’s Hospital, Milano, Italy
Background/Objectives: The literature showed the effectiveness of the treatment with intrathecal baclofen (ITB) therapy in the forms of spastic cerebral palsy and suggested the use of the ITB in patients with secondary dystonia. Moreover, different studies showed a muscle tone reduction in upper limbs as a result of ITB treatment and an improvement of upper limb function in patients with spastic cerebral palsy. The aim of this study is to evaluate upper limb functions in patients with dystonia secondary to cerebral palsy treated through ITB.
Design: Case series
Participants and Setting: We analyzed 10 patients, treated by ITB, affected by dystonia as an outcome of infant cerebral palsy belonged to level II, III and IV of gross motor function classification system (GMFCS) and their mean age at implant time was 11.7 years (SD 2.9).
Materials/Methods: All ten patients implanted with Synchromed pump (Medtronic@) for the intrathecal administration of Baclofen. Before treatment and 12 months after implant, patients were evaluated through Melbourne assessment of unilateral upper limb (MUUL) and barry-albright scale (BAD) to assess upper limb function and dystonia, respectively. Evaluating upper limbs, we identified the dominant limb and carried analysis on total scores for every limb one by one. A P<0.05 was considered significant and all analyses were conducted with Wilcoxon rank rest. Infusion profile and dosage were optimized for each patient on individual needs, caregiver needs, and lifestyle.
Results: We found a significant improvement in both the dominant (P<0.008) and non dominant limb (P<0.041). The MUUL total percentage score for the dominant limb increased in every patient. The total average percentage score increased from 52.9+_ 23.5 to 66 +_ 22.2. Dystonia assessed by BAD scale decreased significantly by 15% from baseline to 12 months follow-up (P<0.005). At baseline, the average percentage of BAD total score was 61.87 +_ 20.40 instead it decreased to 46.56 +_ 14.9 at 12 months post-implant evaluation.
Conclusions/Significance: Patients affected by dystonia as an outcome of CP and treated with ITB reduce global and upper limbs dystonia. Besides, MUUL evaluation assesses an improvement of upper limbs functions. Further studies need to confirm ITB effects on upper limbs for patients affected by dystonia secondary to CP.

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