Other Central Nervous System Devices Intrathecal Baclofen Infusions

Generalized dystonia occurs in 15 to 25 percent of patients with cerebral palsy. These patients typically respond poorly to medical and surgical treatment plans aimed at controlling their dystonia. Baclofen, a g-aminobutyric acid agonist that acts at the level of the spinal cord by impeding the release of excitatory neurotransmitters, decreases spasticity. Oral baclofen offers patients only mild relief because of its inability to cross the blood-brain barrier, because it is poorly lipid soluble. Intrathecal administration is more effective, requires lower doses, and leads to higher CSF levels. Intrathecal baclofen reduces spasticity, improves gait, sitting ability, and upper extremity function in most patients.7!.0 Complications observed in patients receiving continuous intrathecal baclofen include hypotension, bradycardia, apnea, oversedation, respiratory depression, local infection, meningitis, and CSF fistula formation. Newly available intrathecal catheters cause fewer complications compared to original catheters. More experience is needed with continuous intrathecal baclofen to determine the long-term benefits and complications. Currently, it appears that complication occurs in approximately 20 percent of cases, while infection requiring removal occurs in about 5 percent of cases. 789 and 19

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