Intraventricular baclofen for the treatment of pediatric spasticity in cerebral palsy: technique and outcomes

Objective: Intraventricular baclofen (IVB) administration is used for the treatment of secondary dystonia associated with cerebral palsy (CP), but it has not been reported as a first-line infusion technique for spasticity. In this study, the authors report outcomes of patients with mixed or isolated spasticity treated with IVB administration.

Methods: A retrospective analysis was performed of consecutive patients treated with IVB between 2019 and 2023. Demographics, baseline clinical variables, and complications data were collected. The primary outcome of the study was the change in spasticity and dystonia as measured by the modified Ashworth Scale (MAS) and Barry-Albright Dystonia Scale (BADS) scores, respectively. Wilcoxon rank-sum tests were performed to compare the change in the pre- and postoperative scores.

Results: Fifteen patients were implanted with IVB pumps for spasticity related to CP between 2019 and 2023. The median change in the MAS score was 2 (interquartile range [IQR] = 1) and the median change in the BADS score was 1 (IQR = 2). The Wilcoxon rank-sum test revealed a statistically significant change in both scores following IVB pump placement (BADS z = 2.90, p = 0.003; MAS z = 3.2, p = 0.001). Three patients (20%) experienced minor perioperative complications, all of which were self-limiting and none required additional surgery.

Conclusions: This study reported on 15 cases of mixed or isolated spasticity and showed a relative improvement in the MAS and BADS scores after IVB pump placement. These results provide evidence that IVB can be a safe and effective treatment for spasticity-related CP in addition to dystonia. IVB may be advantageous when an intraventricular route of baclofen administration is preferred.