Intrathecal baclofen therapy: complications

Bayhan IA, et al. Infection as a complication of intrathecal baclofen treatment in children with cerebral palsy. J Pediatr Orthop. 2015 Aug 20. [Epub ahead of print]

“Major complications of ITB can be classified as medication-related complications (adverse effects, withdrawal); immediate postoperative problems, such as cerebrospinal
fluid leak, wound dehiscence and seroma, and infection at pump or catheter site; and late complications, such as pump and catheter problems, skin breakdown, or human error. In the current literature, few articles focus on infection and infection treatment outcomes in this pediatric population. [9–14] The aim of this study is to evaluate the risk factors and treatment outcomes of infections associated with ITB in children with CP.”

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Haranhalli N, et al. Intrathecal baclofen therapy: complication avoidance and management. Childs Nerv Syst. 2011 Mar;27(3):421-7.

“Intrathecal baclofen is widely used for treating spasticity, increasing the functionality in these patients and their overall quality of life. While the efficacy of ITB therapy has been supported by various studies [2, 7, 18, 23, 26, 32], there is still a wide range of complications associated with the treatment. Approximately 20–30% of patients with
baclofen pumps have complications [14, 22], these include baclofen-related complications (overdose and withdrawal), infections (surgical site infections, hardware infections, and meningitis), and hardware-related complications (malfunction, leaks, etc). The most frequent complications include infections, CSF leaks, and catheter malfunctions [7, 31, 32]. Rarely, baclofen withdrawal and overdose can also occur
[9, 12, 19].”

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Borowski A, et al. Complications of intrathecal baclofen pump therapy in pediatric patients. J Pediatr Orthop. 2010 Jan-Feb;30(1):76-81.

“In our study, 12.3% of all procedures were associated with device-related complications. Of these, 63% were a result of complications caused by catheter problems such as catheter break, disconnection, and catheter malfunction. All of these complications were easily treated by catheter replacement. No patient had more than 1 catheter-related problem. Catheter-related complications are relatively common in other studies. [2,4,15,16,18–22] Vender et al, [22] in 2006, reported in a population of 116 children that most complications requiring repeated operation involved catheter and/or infection with nearly equal numbers of both complication types. [21] In their study, catheter complications were the most commonly encountered problem in adults. However, the difference in total overall numbers of procedures (elective and complication-related) was statistically significantly higher in the pediatric group. Campbell et al [4] reported that 33% patients had complications associated with the device; of these, 50% were caused by catheter breakage, blockage, or leak. Gerszten et al [15] reported an 8.3% catheter-related complication rate with no occurrence of pump malfunctions. In another study, 23% of patients required a revision of their pump for malfunction secondary to catheter-related problems. [2] Awaad et al [3] reported catheter dislocation in 10% of their patients. Overall, our rate of catheter problems was similar to other reports in adults, and focuses on the need to continue to improve catheter design.”

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Dvorak EM, McGuire JR, Nelson ME. Incidence and identification of intrathecal baclofen catheter malfunction. PM R. 2010 Aug;2(8):751-6.

“On the basis of a systematic review of the diagnostic studies used to identify patients with suspected ITB pump/catheter malfunction, a troubleshooting flow chart was developed. Timely identification and correction of potential ITB complications could improve the clinical effectiveness of ITB and may reduce unnecessary health-care costs. Centers that rely on radiographs alone to identify pump/catheter problems may miss up to two-thirds of potential problems. Fluoroscopic-guided catheter contrast dye study with CT follow-up should be used to identify subdural catheter migration/placement. Lower extremity H -reflex studies and having the ability to measure pump and/or catheter pressures and reserve volumes could assist in the early detection of potential problems, but additional study is needed.”

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Gooch JL, Oberg WA, Grams B, Ward LA, Walker ML. Complications of intrathecal
baclofen pumps in children. Pediatr Neurosurg. 2003 Jul;39(1):1-6.

Intrathecal baclofen is increasingly being used to manage severe spasticity in children. Although substantial tone reduction with this treatment has been documented, complications also occur. In this study, we describe the device- and major non-device-related complications in a group of 100 consecutive children and young adults who received 117 intrathecal baclofen pumps for the management of severe spasticity. Twenty-four patients (24%) experienced a total of 48 complications. The most common complication was disconnection of the catheter at its connection to the pump, occurring in 9% of pumps implanted. This complication occurred more frequently in pumps with catheter access ports (16%) than in those without ports (2%). Catheter dislodgement from the intrathecal space was the next most common complication, occurring in 8% of pumps implanted (13% of pumps with ports, 4% of pumps without ports). To decrease the occurrence of the most common complications of intrathecal pumps, we now typically implant pumps without catheter access ports, and we use 2-piece catheters. Although the lack of an access port may be a disadvantage for troubleshooting, most complications can be detected in pumps without a port. Patient and family education is critical in preventing serious consequences of baclofen withdrawal resulting from catheter-related complications.

Full-text for Children’s and Emory users.

More PubMed results on ITB complications.

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