TY - JOUR
T1 - Effect of continuous intrathecal baclofen therapy in children
T2 - a systematic review
AU - Buizer, Annemieke I.
AU - Martens, Brian H. M.
AU - van Ravenhorst, Casey Grandbois
AU - Schoonmade, Linda J.
AU - Becher, Jules G.
AU - Vermeulen, R. Jeroen
N1 - Funding Information:
OBJETIVO Investigar los efectos de la terapia con baclofeno intratecal continuo (BIT) en condiciones neurológicas. METODO Esta revisión sistemática utilizo metodología estandarizada, buscando en cuatro bases de datos electrónicas (PubMed, Embase, CINAHL, Cochrane Library) literatura relevante publicada entre el comienzo de BIT y septiembre del 2017. Los estudios incluidos involucraron BIT continuo como una intervención y la medición de resultados incluía todos los componentes relacionados a la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud para niños y jóvenes (ICF-CY en inglés). RESULTADOS Treinta y tres estudios fueron identificados, de los cuales uno, incluyo 17 niños con PC espástica, produciendo un nivel II de evidencia, y los otros, principalmente estudios de cohorte no controlados nivel IV y V. Los resultados sobre el nivel de función corporal, fue reportado con mayor frecuencia. Los resultados sugieren que la BIT continua puede ser efectiva en reducir la espasticidad y la distonía en PC, asítambién en otras condiciones neurológicas, y puede facilitar el cuidado y la calidad de vida de los niños con PC, pero el nivel de evidencia es bajo. INTERPRETACION′ A pesar de tres de′cadas de aplicacio′n de BIT en nin~os, con un relativo largo nu′mero de estudios investigando
Publisher Copyright:
© 2018 The Authors Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press
PY - 2019/2
Y1 - 2019/2
N2 - Aim To investigate the effects of continuous intrathecal baclofen (ITB) therapy in children with cerebral palsy (CP) and other neurological conditions. Method This systematic review was conducted using standardized methodology, searching four electronic databases (PubMed, Embase, CINAHL, Cochrane Library) for relevant literature published between inception and September 2017. Included studies involved continuous ITB as an intervention and outcome measures relating to all International Classification of Functioning, Disability and Health: Children and Youth (ICF-CY) components. Results Thirty-three studies were identified, of which one, including 17 children with spastic CP, produced level II evidence, and the others, mainly non-controlled cohort studies, level IV and V. Outcomes at body function level were most frequently reported. Results suggest continuous ITB may be effective in reducing spasticity and dystonia in CP, as well as other neurological conditions, and may improve the ease of care and quality of life of children with CP, but the level of evidence is low. Interpretation Despite three decades of applying ITB in children and a relatively large number of studies investigating the treatment effects, a direct link has not yet been demonstrated because of the low scientific quality of the primary studies. Further investigation into the effects of continuous ITB at all levels of the ICF-CY is warranted. Although large, controlled trials may be difficult to realize, national and international collaborations may provide opportunities. Also, multicentre prospective cohort studies with a long-term follow-up, employing harmonized outcome measures, can offer prospects to expand our knowledge of the effects of continuous ITB therapy in children. What this paper addsThere is low-level evidence for continuous intrathecal baclofen (ITB) in children with cerebral palsy. Continuous ITB is effective in reducing spasticity and dystonia in non-controlled cohort studies. Evaluation of individual goals and systematic assessment of long-term effects in large cohort studies are required.
AB - Aim To investigate the effects of continuous intrathecal baclofen (ITB) therapy in children with cerebral palsy (CP) and other neurological conditions. Method This systematic review was conducted using standardized methodology, searching four electronic databases (PubMed, Embase, CINAHL, Cochrane Library) for relevant literature published between inception and September 2017. Included studies involved continuous ITB as an intervention and outcome measures relating to all International Classification of Functioning, Disability and Health: Children and Youth (ICF-CY) components. Results Thirty-three studies were identified, of which one, including 17 children with spastic CP, produced level II evidence, and the others, mainly non-controlled cohort studies, level IV and V. Outcomes at body function level were most frequently reported. Results suggest continuous ITB may be effective in reducing spasticity and dystonia in CP, as well as other neurological conditions, and may improve the ease of care and quality of life of children with CP, but the level of evidence is low. Interpretation Despite three decades of applying ITB in children and a relatively large number of studies investigating the treatment effects, a direct link has not yet been demonstrated because of the low scientific quality of the primary studies. Further investigation into the effects of continuous ITB at all levels of the ICF-CY is warranted. Although large, controlled trials may be difficult to realize, national and international collaborations may provide opportunities. Also, multicentre prospective cohort studies with a long-term follow-up, employing harmonized outcome measures, can offer prospects to expand our knowledge of the effects of continuous ITB therapy in children. What this paper addsThere is low-level evidence for continuous intrathecal baclofen (ITB) in children with cerebral palsy. Continuous ITB is effective in reducing spasticity and dystonia in non-controlled cohort studies. Evaluation of individual goals and systematic assessment of long-term effects in large cohort studies are required.
KW - DYSTONIA
KW - EFFICACY
KW - HYPERTONIA
KW - INFUSION
KW - LIFE
KW - NON-AMBULANT CHILDREN
KW - OUTCOMES
KW - SAFETY
KW - SPASTIC CEREBRAL-PALSY
KW - YOUNG-ADULTS
KW - Hypertonia
KW - Efficacy
KW - Outcomes
KW - Infusion
KW - Non-ambulant children
KW - Life
KW - Dystonia
KW - Safety
KW - Spastic cerebral-palsy
KW - Young-adults
U2 - 10.1111/dmcn.14005
DO - 10.1111/dmcn.14005
M3 - (Systematic) Review article
C2 - 30187921
SN - 0012-1622
VL - 61
SP - 128
EP - 134
JO - Developmental Medicine and Child Neurology
JF - Developmental Medicine and Child Neurology
IS - 2
ER -