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  • Intrathecal Baclofen Therapy in Severely Disabled Cerebral Palsy Patients - Efficacy and Cost-benefit Analysis

    Final Number:

    Alexandra Santos MD; Carla Reizinho; Miguel Vasconcelos Casimiro MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Cerebral palsy (CP) has an incidence of 2-3 per 1000 live births in industrialized countries. Spastic cerebral palsy is the most common form of this condition. Spasticity can cause pain, sleeping disorders and interference with positioning, transfers, dressing and body hygiene, causing a negative impact on patient and caregiver quality of life. Intrathecal baclofen therapy (ITB) has been proved to have efficacy however its cost/benefit might be questioned. Our aim is to acess its efficacy and cost/benefit in the treatment of non-ambulatory patients with spastic cerebral palsy.

    Methods: Retrospective analysis of baclofen pumps implantation for severe spastic CP between 2000 and 2013, at Centro Hospitalar de Lisboa Ocidental (Portugal), including data before and after implantation. Assessments included: modified Ashworth score, Peen spasm frequency score, Gross motor function, manual classification system, EQ-5D and NRS (numeric rating scale) score for several daily-life items.

    Results: 20 patients received ITB during this period. 16 patients with minimum follow-up of 12 months (range 1-13 years) were included for statistical analysis, with average age of 19.72 ± 10.37 (9-42). After ITB modified Ashworth score improved from 3.6± 0.5 to 1.9± 0.5 and Peen spasm frequency score improved from 2.0± 1.3 to 0.7± 0.8. There were improvements in hygiene (NRS 7.44±1.24), dressing (NRS 7.53 ± 1.30) and wheelchair posturing (NRS 7.28 ± 2.3). NRS for patient life quality improvement was 8.2±1.5 and for caregiver life quality improvement was 8.1± 1.7. There was an average 0.14 QOL improvement in EQ-5D score, which corresponds to 33045€/QALY. Overall, 100% of ITB patients were satisfied, with NRS 8.3± 1.5 and 87% would go through the procedure again.

    Conclusions: ITB is effective in reducing spasticity and spasm frequency in severally disabled CP patients. This reduction facilitates daily life activities, which improves patient and caregiver life quality in a cost/effective manner.

    Patient Care: By confirming the efficacy and cost/benefit of intratechal baclofen therapy in non-ambulatory cerebral palsy patients

    Learning Objectives: Confirm efficacy and cost/benefit of intratechal baclofen treatment of non-ambulatory patients with severe spastic cerebral palsy.

    References: Paediatrics and Child Health (2008) 18 (9): 393-398; European Journal of Paediatric Neurology (2010) 19-28; Developemental Medicine & Child Neurology (2008) 50:450-455; J Neurosurg (2002) 96:1052-1057

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