Whiteness, redness, blueness and greenness profile assessment and design of experiments approach to microwave-aided sensitive and green spectrofluorophotometric determination of baclofen.

As a gamma amino butyric acid-ergic agonist, Baclofen is often prescribed to adults and children for the treatment of severe spasticity that originates in the brain or spinal cord. Even after reviewing the literature extensively, no one has documented a method for estimating baclofen using microwave-assisted stability-indicating spectrofluorimetric techniques, despite the abundance of options for baclofen stability, assay, and bioanalysis. Organic solvents, which are typically necessary for current procedures but may be costly and toxic, have a severe effect on aquatic life and the environment. Using green solvents and 4-chloro-7-nitrobezofuran as a fluorescent probe, this work conducted a stability-indicating spectrofluorimetric estimate of baclofen. Through the use of a design-of-experiments technique, a reliable microwave-aided spectrofluorimetric method was developed, with little solvent consumption and time for sample analysis. Prior to conducting response surface analysis and optimizing important variables and responses, a fractional factorial design was used to screen method variables and responses. A central composite design was then employed for these purposes. This flexible spectrofluorimetric technique was used to assess baclofen concentrations in forced degraded samples and marketed formulations. For baclofen determination, the suggested spectrofluorimetric approach was found to be green, quick, easy to use, economical, and user-friendly.

Complications of intrathecal baclofen therapy in children and young adults.

OBJECTIVE: The primary objective of this study was to determine the frequency and nature of complications that occur during intrathecal baclofen (ITB) therapy, including nonsurgical complications as well as complications associated with both implantation surgeries and subsequent revisions. METHODS: The authors retrospectively reviewed the medical records of all patients who had baclofen pumps implanted at a tertiary children's hospital from 2006 through June 2019. The study employed appropriate descriptive statistics and statistical models to analyze patient demographics, improvements in tone, and clinical complications. The authors evaluated the associations of complications as well as changes in modified Ashworth Scale (MAS) scores with various preexisting conditions (e.g., presence of gastrostomy tubes [G-tubes] and ventriculoperitoneal [VP] shunts) and surgical variations (e.g., use of newer [Ascenda] catheters and subfascial versus subcutaneous catheter tunneling). RESULTS: One hundred forty-two pumps were implanted. Complications occurred in 111 patients (78.2%). The most frequent complications were catheter complications and pseudomeningoceles, each of which occurred in 63 (44%) patients. On multivariable analysis, pseudomeningoceles and percutaneous CSF leaks were significantly less likely when intrathecal catheters were placed via laminotomy versus spinal needle (OR 4.6, p = 0.044), and when catheters were passed from the posterior incision to the abdominal pump pocket deep to the thoracolumbar fascia rather than superficial to it (OR 2.7, p = 0.008). Preexisting G-tubes and VP shunts at the time of pump implantation were not associated with a significantly increased likelihood of pump malfunction or infection. Ascenda catheters were significantly less likely to have disconnections (p < 0.001) and obstructions (p = 0.016), and overall were less likely to have any catheter-related complications (p = 0.01). Patients with preexisting VP shunts at the time of implantation had a significantly greater mean decrease in MAS scores in both their lower extremities (1.8, p = 0.003) and upper extremities (1.3, p = 0.002) than did patients without shunts. CONCLUSIONS: Various complications are associated with ITB therapy, most commonly catheter complications and pseudomeningoceles. There have been fewer catheter complications associated with the newest catheter model, while pseudomeningoceles have become less frequent since the surgical technique was modified to prevent them. VP shunts and G-tubes are not associated with significantly higher complication rates and shunts seem to be associated with greater efficacy of ITB therapy, as represented by a greater mean improvement in MAS scores.

Comparative Assessment of the Effectiveness of Carbamazepine and Baclofen in the Management of Trigeminal Neuralgia.

Objectives: The study aimed to compare the effectiveness of carbamazepine and baclofen in the medical management of trigeminal neuralgia. Materials and Methods: 100 trigeminal neuralgia patients were randomly divided into two groups with 50 samples in each. Group A had patients treated with carbamazepine while Group B comprised of patients treated using baclofen. Follow-up was performed on the initial, 15 days, 1 month, and 3 months duration. The data was statistically evaluated. Results: Carbamazepine showed a "good response" in 54.39% of patients at initial follow-up, and adverse side effects increased in 20-29.49% of patients from the initial to 3-month duration. On the other hand, baclofen demonstrated a "good response" in 54.45% of patients at initial follow-up. At 800 mg, a "good response" was noted in 87.9% of patients, whereas 16.9% of patients had an "average response" and a "good response" after 1 month. At 3 months, 99.87% of patients showed a "good response." Both groups showed similar success rates after 3 months. Conclusion: Adverse effects incidence and success were similar in both groups.

Peritoneal baclofen pump migration: a rare complication of subfascial placement. Illustrative cases.

BACKGROUND: The intrathecal baclofen pump is an effective treatment option for patients with severe spasticity. In children, subfascial pump placement is often preferred given concerns for infection and wound healing. However, this approach is not without risk, and rare complications, such as peritoneal pump migration, can occur. OBSERVATIONS: The authors describe three pediatric cases of peritoneal pump migration at their institution over the past 14 years (3/545, 0.5%). All three patients had low body weight (below the 39th percentile), and two had scoliosis requiring surgery. All pumps had been placed using the subfascial technique. The first case occurred 6 months postplacement, and the pump was not replaced. Cases 2 and 3 occurred at 2 and 3 years postplacement, respectively, and both pumps were replaced. LESSONS: The authors conclude that peritoneal pump migration, although uncommon, can occur in patients with subfascial pump placement, and providers should have a low threshold of suspicion for repeat imaging prior to refilling if the pump's location has migrated. Potential contributing factors to pump migration include a patient's small size, a larger pump size (40-mL pump), and scoliosis. All these factors should be considered during pump placement, and surgeons can consider using a 20-ml pump for smaller patients. https://thejns.org/doi/abs/10.3171/CASE24290.

Content and readability of patient educational materials about neuromodulation for childhood movement disorders.

PURPOSE: To assess content and readability of online patient educational materials (PEMs) for paediatric deep brain stimulation (DBS) and intrathecal baclofen (ITB). METHODS: A content analysis of PEMs identified from top children's hospitals, institutions affiliated with published neuromodulation research, and DBS and ITB device manufacturers was conducted. PEM content was analysed using a predetermined framework. Readability was assessed using the Simple Measure of Gobbledygook (SMOG). RESULTS: Of 109 PEMs (72 DBS; 37 ITB) identified, most (77 (71%)) originated in the United States. More ITB PEMs (27 (73%)) contained specific paediatric information than DBS PEMs (16 (22%)). PEMS more frequently described benefits (DBS: 92%; ITB: 89%) than risks (DBS: 49%; ITB: 78%). Frequent content included pre- and post-operative care, procedural details, and device information. Less common content included long-term lifestyle considerations, alternatives, patient experiences, and financial details. Median readability of PEMs was 13.2 (interquartile range [IQR]: 11.4-14.45) for DBS and 11.8 (IQR: 11-12.9) for ITB. CONCLUSIONS: Available ITB and DBS PEMs often miss important broader details of the treatments, and have additional shortcomings such as poor readability scores. Our findings highlight need for more holistic content within neuromodulation PEMs, improved accessibility, and more balanced representation of risks and benefits.

Neuromodulation patient education materials (PEMs) require more comprehensive information to address needs of families of children with movement disorders.There is a paucity of online PEMs for paediatric deep brain stimulation (DBS), and limited English-language neuromodulation information originating outside the USA.Neuromodulation PEMs do not meet readability standards and underutilise testimonials and audiovisual communication.Benefits of neuromodulation are described more frequently than risk information in PEMs.

Should the French approval of baclofen for alcohol dependence be extended to abstinence maintenance?

Ever since 2018 France has been the only country to approve the gamma aminobutyric acid type B (GABA-B) receptor agonist baclofen for alcohol dependence. This authorization follows a ten-year period of intensive off-label use during which baclofen was used in doses of up to 300 and even 400mg per day to support the gradual reduction of alcohol consumption in patients suffering from alcohol dependence. However, in international clinical trials, baclofen has mainly been studied to support the maintenance of abstinence. The French use of baclofen was therefore somewhat atypical as it paved the way for drug-supported approaches to reducing alcohol consumption, even before nalmefene was marketed. In line with this specific use of baclofen, approval was granted only for alcohol reduction support. However, a recent Cochrane systematic review and meta-analysis by Agabio et al. found significant efficacy only for abstinence maintenance, while no significant effect was found on alcohol reduction outcomes and no dose-response relationship was identified in the analyses. The safety of baclofen was judged to be good. Based on these substantial new results, the Société française d'alcoologie (SFA) now considers that baclofen should also be approved for the maintenance of abstinence. The extension of approval should not lead to the removal of the initial indication or the possibility of using high doses, as some patients have found this therapeutic regimen particularly useful for them. France, which has been a open skies national laboratory on the use of baclofen in alcohol dependence for over ten years, should let this original therapeutic option available to patients. However, it should update the regulatory framework defining the main conditions of access to treatment for patients based on the latest and highest scientific evidence.

INTRATHECAL BACLOFEN FOR NEUROFIBROMATOSIS RELATED SPINAL CORD INJURY WITH SPASTICITY - A CASE REPORT.

This case presents a 35-year-old male with spinal predominant neurofibromatosis-1 who developed an incomplete spinal cord injury (C3 Asia C) which did not improve despite urgent decompressive surgery for multiple cervical neurofibromas. This report outlines a novel indication for intrathecal baclofen. The patient suffered from lower limb weakness with severe spasticity and required assistance of at least two for all activities. The aim of rehabilitation was to improve overall tone while focusing on independence, mobility and quality of life. After a successful trial of intrathecal baclofen, he underwent implantation of an intrathecal baclofen pump. The dose was gradually increased while he received a progressive programme of stretching and functional rehabilitation therapy. After 6 weeks, his MAS had improved to 1-2/4 and he had progressed to independent transfers, independence for most activities of daily living and was able to discharge to his family home with minimal support.

Neurofibromatosis type 1 is a rare disorder causing various skin, skeletal, and neurological issues, including spinal cord injury due to tumours and severe scoliosis. Current treatment is supportive, with surgery sometimes needed for acute injuries. Spasticity, a common complication, leads to functional impairments and reliance on medications with side effects. Intrathecal baclofen pumps offer a targeted solution, delivering baclofen directly into the spine to reduce side effects. We present a case where a gentleman with neurofibromatosis-1-related spinal cord injury received intrathecal baclofen, coupled with intensive rehabilitation, to enhance comfort and daily independence. This case showcases the potential of intrathecal baclofen in managing spasticity in neurofibromatosis-1-related spinal cord disease.

Transcending Traditional Treatment: The Therapeutical Potential of Nanovesicles for Transdermal Baclofen Delivery in Repeated Traumatic Brain Injury.

Purpose: The repositioning of previously approved drugs is occupying the researchers' plans. Baclofen (Bac) was our candidate for its established neuroprotective capacity, with a proposal of efficient drug delivery as non-ionic surfactant-based nanovesicles (NISNV) formulae against mild repetitive traumatic brain injury (mRTBI) in rats, thus reducing the number of orally or injected medications, especially in severely comatose patients or pediatrics. Methods: A (23) factorial design was implemented for confining Bac-loaded NISNV formulae, where a bunch of variables were inspected. An in-vivo experiment was done to test the prepared formula's efficacy transdermally. The following parameters were measured: brain expression of gamma amino butyric acid B (GABAB), protein kinase C- α (PKC-α), focal adhesion kinase (FAK), TNF-α and nuclear factor kappa B (NF-κB) p65, malondialdehyde (MDA), superoxide dismutase (SOD), and histopathology. Results: The particle size (PS) and entrapment efficiency percent (EE%) speckled from 60.40±0.28% to 88.02±0.01% for the former and 174.64±0.93 to 1174.50±3.54 nm for the latter. In vitro release% after 8 hours ranged from 63.25±5.47% to 84.79±3.75%. The optimized formula (F4) illustrated desirability=1, with 630.09±3.53 µg/cm2 of Bac permeated over 8 hours, which equates to 100% of Bac. Bac post-trauma treatment restored brain expression of GABAB and PKC-α, while decreasing FAK. Besides enhancing the histological findings, the anti-inflammatory effect was clear by decreasing TNF-α and NF-κB p65. Consequently, significant antioxidant sequelae were revealed herein by diminishing MDA levels and restoring SOD activity. Conclusion: Transdermal delivery of Bac-loaded niosomes confirmed neuroprotection and succeeded in surpassing skin-to-brain barriers, which makes it a promising therapeutic option for repeated traumas.

Baclofen-induced excessive perspiration: A case report and review of literature.

This report highlights an unexpected baclofen side effect, a medication known for its safety profile. The rarity of excessive perspiration as a side effect distinguishes this case from typical baclofen adverse reactions. Documenting uncommon reactions is vital for physicians to broaden their awareness of baclofen's side effects and improve care.

Baclofen-induced neurotoxicity in a dialysis patient managed with continuous venovenous hemodialysis: A case report and literature review.

Despite documented cases of baclofen toxicity in individuals with kidney disease, the drug is widely prescribed for various medical conditions, primarily spasticity, hiccups, and multiple sclerosis. Baclofen, a gamma-aminobutyric acid derivative, relies on renal excretion, rendering those with impaired kidney function susceptible to toxicity - a concern often underestimated by health-care providers. Adverse reactions, including single or double doses, are well documented in addition to multi-dose toxicity. This report discusses a case of baclofen-induced neurotoxicity in an end-stage renal disease patient undergoing dialysis, highlighting the subsequent management with continuous venovenous hemodialysis. In addition, it provides a comprehensive review of existing literature on baclofen toxicity in cases of renal insufficiency. Strikingly, the literature lacks clear guidelines regarding baclofen safety, dose adjustments, or renal function thresholds for contraindication. This contribution aims to augment understanding of this critical issue, emphasizing the need for heightened awareness and careful consideration of baclofen use in patients with kidney disease.

Intractable Hiccups in a Patient With End-Stage Renal Disease: A Five-Month Ordeal Resolved Through Hemodialysis.

Hiccups, a common and usually self-limiting condition, are caused by involuntary, spasmodic contractions of the diaphragm and intercostal muscles, followed by the sudden closure of the glottis. While most cases resolve spontaneously, persistent hiccups (lasting 48 hours to one month) and intractable hiccups (lasting more than one month) require medical attention. Intractable hiccups, although rare, can significantly impair a patient's quality of life. The etiology of intractable hiccups is diverse, but they are often associated with serious underlying medical conditions, such as severe renal dysfunction and uremia. We present the case of a 72-year-old male patient with stage IV chronic kidney disease (CKD) who developed intractable, violent hiccups following a mild COVID-19 infection. Despite treatment attempts with chlorpromazine and baclofen, the hiccups persisted for five months and only resolved after the initiation of hemodialysis. Interestingly, the patient's renal function deteriorated significantly during the period of hiccup persistence, suggesting a possible link between the hiccups and the progression of CKD, likely exacerbated by COVID-19. This case highlights the challenges of managing intractable hiccups in patients with advanced CKD and emphasizes the importance of addressing underlying metabolic derangements in such complex clinical scenarios. Moreover, it contributes to the growing evidence supporting the role of dialysis in resolving intractable hiccups associated with severe renal dysfunction.

A case of severe and prolonged γ-hydroxybutyrate (GHB) withdrawal syndrome successfully managed with a slow benzodiazepine and baclofen taper.

INTRODUCTION: γ-hydroxybutyrate (GHB) is a GABA-B agonist that rapidly produces effects that are likened to both alcohol and MDMA/ecstasy. GHB use can lead to neuroadaptation with a characteristic withdrawal syndrome. There is currently a paucity of data on the progression of GHB withdrawal, however, due to the drug's short half-life it is generally considered to be typically 5-7 days, although some cases can be severe and complicated by life threatening delirium. Here, we present a case of severe GHB withdrawal, which recurred on multiple occasions over 56 days, despite initial clinical stabilisation on each occasion and toxicological evidence of abstinence from GHB between episodes. CASE PRESENTATION: A male patient in his 30s presented with agitated delirium on a background of severe GHB use disorder with a 15-year history of daily high dose GHB use. Following 3 hospital admissions over 8 weeks, all requiring intravenous sedation and tracheal intubation, the patient's withdrawal delirium was successfully treated with a slow benzodiazepine and baclofen wean over a period of 6 months. Relapse to GHB use between hospitalisations was excluded toxicologically via blood analysis performed at an institute of forensic pathology. DISCUSSION AND CONCLUSIONS: This case highlights that GHB withdrawal can be more prolonged than previously reported in the literature and in some cases may require slow and prolonged tapering of treatment to prevent re-emergence of delirium. Similar to previous case reports, benzodiazepines and GABA-B receptor agonists appear to be appropriate drug classes to manage GHB withdrawal.

Baclofen prevents morphine rewarding effects and associated biochemical alterations in male and female mice.

Previous studies from our laboratory have shown sex differences in the behavioral, molecular, and neurochemical manifestations of morphine withdrawal and they were related to an increased sensitivity to morphine effects in males. In addition, we observed an interaction between the GABAergic and opioid systems that could also be sex-dependent. Baclofen, a GABAB receptor agonist, prevented the somatic expression and the molecular and neurochemical changes induced by morphine withdrawal syndrome in mice. On the contrary, little is known about baclofen effects in the rewarding properties of morphine in male and female mice. The present study aimed to explore the effect of baclofen (1, 2 and 3 mg/kg, i.p.) pretreatment in the rewarding effects induced by morphine (7 mg/kg, s.c.) and its effect on c-Fos and brain-derived neurotrophic factor (BDNF) expression induced by the rewarding properties of morphine in prepubertal male and female mice. Baclofen (2 mg/kg) pretreatment prevented the rewarding effects of morphine only in male mice, while baclofen (3 mg/kg) reduced these effects in both sexes. Moreover, the rewarding effects of morphine were associated with a decrease of BDNF and c-Fos expression cingulate cortex, nucleus accumbens shell, cornu ammonis 1 (CA1), and cornu ammonis 3 (CA3) areas of the hippocampus only in male mice. In addition, baclofen pretreatment prevented these changes in BDNF, but not in c-Fos expression. In conclusion, our results show that GABAB receptors have a regulatory role in the rewarding effects of morphine that could be of interest for a potential future therapeutic application in opioid use disorders.

R-Baclofen Treatment Corrects Autistic-like Behavioral Deficits in the RjIbm(m):FH Fawn-Hooded Rat Strain.

The Fawn-hooded rat has long been used as a model for various peripheral and central disorders and the data available indicate that the social behavior of this strain may be compromised. However, a thorough description of the Fawn-hooded rat is unavailable in this regard. The objective of the present study was to investigate various aspects of the Fawn-hooded rat's social behavior in depth. Our results show that several facets of socio-communicational behavior are impaired in the RjIbm(m):FH strain, including defective ultrasonic vocalizations in pups upon maternal deprivation, reduced social play in adolescence and impaired social novelty discrimination in adulthood. In addition, Fawn-hooded rats exhibited heightened tactile sensitivity and hyperactivity. The defects observed were comparable to those induced by prenatal valproate exposure, a widely utilized model of autism spectrum disorder. Further on, the pro-social drug R-baclofen (0.25-1 mg/kg) reversed the autistic-like defects observed in Fawn-hooded rats, specifically the deficiency in ultrasonic vocalization, tactile sensitivity and social novelty discrimination endpoints. In conclusion, the asocial, hypersensitive and hyperactive phenotype as well as the responsivity to R-baclofen indicate this variant of the Fawn-hooded rat strain may serve as a model of autism spectrum disorder and could be useful in the identification of novel drug candidates.

Postoperative outcomes and stimulation responses for sectioned nerve roots during selective dorsal rhizotomy in cerebral palsy.

BACKGROUND: Cerebral palsy (CP) is the most cause of motor dysfunction in children. Selective dorsal rhizotomy (SDR) plays a major role in long term spasticity control. However, limited data exists on the effect of SDR on postoperative spasticity treatment requirements and supraspinal effects, and the stimulation responses of dorsal nerve roots in those with CP. METHODS: The current study included the outcome for 35 individuals undergoing SDR for motor functional outcome, spasticity, baclofen dose changes, botulinum toxin injection frequency, and spasticity related orthopedic procedures. We also report on the stimulation responses in 112 individuals who underwent SDR at our institution. RESULTS: There was a significant difference in gross motor function measures (GMFM)-66 scores at last follow up that remained present when considering only ambulatory children but not with non-ambulatory children. Ashworth scores were significantly decreased for both upper and lower extremities after SDR at all follow up points. There was a significant decrease in Baclofen dose and botulinum toxin injections requirements after SDR, but no significant difference in the need for orthopedic intervention. A total of 5502 dorsal nerve roots were tested showing a decrease in stimulation intensity and increase in grade on the right side and for descending lumbosacral levels. CONCLUSIONS: SDR improves gross motor scores during short term follow up but has additional benefits in decreasing baclofen dosing and botulinum toxin injections requirements after surgery. They stimulation responses of sectioned dorsal nerve roots adds to the limited available data and our understanding of the pathological changes that occur in CP.

An Uncommon Side Effect of Baclofen Withdrawal in End Stage Renal Disease.

Baclofen is a commonly prescribed muscle relaxant that functions to reduce spasticity associated with a variety of musculoskeletal and neurological conditions. Patients with decreased renal function, however, are at an increased risk of suffering from baclofen withdrawal symptoms. We discuss the case of a 77-year-old male who presented to the emergency room with altered mental status and was admitted for acute metabolic encephalopathy found to be from abrupt cessation of baclofen. The presence of kidney disease in this patient further increased his susceptibility to the withdrawal symptoms that began after cessation of the normal medication regimen. This case further illustrates the importance of both comprehensive history and a high index of suspicion when it comes to patient presentation of baclofen withdrawal.

Uncovering the rate and risk factors of intrathecal baclofen pump-associated complications in the adult population.

OBJECTIVE: The aim of this study was 1) to describe the rate of intrathecal baclofen (ITB)-associated complications at a large tertiary center, and 2) to evaluate the impact of patient-related factors on the likelihood of developing such complications. METHODS: A retrospective single-center study was carried out. A total of 301 eligible patients were included in the analysis. Univariate regression models were used to evaluate the impact of age, sex, diagnosis, ambulation status, modified Ashworth scale score, body mass index, diabetes status, and pain level on the likelihood of developing a device-related infection, pump malfunction, catheter malfunction, and other clinically significant complications. RESULTS: Overall, 27% of patients experienced an ITB-related complication. The most common complications included infection (6%, 18/301), pump malfunction (7.3%, 22/301), and catheter malfunction (14%, 42/301). The univariate analyses revealed that the patient's ambulatory status had a significant impact on the likelihood of developing a catheter-related malfunction. Furthermore, a trend toward significance was identified between patients' preoperative body mass index and device-related infection. Finally, the risk of suffering any ITB-related complications was statistically correlated with the number of years that had passed since the initial pump implantation. CONCLUSIONS: The authors' analysis reveals a previously underrecognized association between ambulatory status at the time of ITB pump implantation and the incidence of catheter-related complications, and confirms the impact of time since surgery on the risk of developing any ITB-related complication. The patient's age, sex, diagnosis, diabetes status, or pain level at baseline were not associated with the risk of complications. Collectively, these insights contribute novel information to the existing literature, providing practical value for physicians in guiding patient selection for ITB therapy.

History and evolution of surgical treatment for spasticity: a journey from neurotomy to selective dorsal rhizotomy.

The evolution of neurosurgical approaches to spasticity spans centuries, marked by key milestones and innovative practitioners. Probable ancient descriptions of spasmodic conditions were first classified as spasticity in the 19th century through the interventions of Dr. William John Little on patients with cerebral palsy. The late 19th century witnessed pioneering efforts by surgeons such as Dr. Charles Loomis Dana, who explored neurotomies, and Dr. Charles Sherrington, who proposed dorsal rhizotomy to address spasticity. Dorsal rhizotomy rose to prominence under the expertise of Dr. Otfrid Foerster but saw a decline in the 1920s due to emerging alternative procedures and associated complications. The mid-20th century saw a shift toward myelotomy but the revival of dorsal rhizotomy under Dr. Claude Gros' selective approach and Dr. Marc Sindou's dorsal root entry zone (DREZ) lesioning. In the late 1970s, Dr. Victor Fasano introduced functional dorsal rhizotomy, incorporating electrophysiological evaluations. Dr. Warwick Peacock and Dr. Leila Arens further modified selective dorsal rhizotomy, focusing on approaches at the cauda equina level. Later, baclofen delivered intrathecally via an implanted programmable pump emerged as a promising alternative around the late 1980s, pioneered by Richard Penn and Jeffrey Kroin and then led by A. Leland Albright. Moreover, intraventricular baclofen has also been tried in this matter. The evolution of these neurosurgical interventions highlights the dynamic nature of medical progress, with each era building upon and refining the work of significant individuals, ultimately contributing to successful outcomes in the management of spasticity.

Spinal catheter revision in pediatric intrathecal baclofen pumps: risk factors and postoperative outcomes.

OBJECTIVE: Intrathecal baclofen (ITB) pumps are commonly used in pediatric patients with cerebral palsy (CP) and medically refractory spasticity. However, catheter malfunction and associated risk factors are not well understood. The aim of this study was to examine potential risk factors for spinal catheter malfunction and characterize postoperative follow-up to understand the clinical consequences. METHODS: Patients who received ITB pump replacement or revision at Boston Children's Hospital between 2010 and 2023 were retrospectively reviewed. The spinal catheter revision cohort (SCRC) included patients whose spinal catheter was occluded requiring lumbar catheter revision. The second cohort included abdominal pump replacements only (APRC). Between-group comparisons and multivariable regression identified factors associated with catheter revision and postoperative outcomes. RESULTS: Forty-one (33.6%) patients underwent spinal catheter revision and were compared with 81 patients (66.4%) who underwent abdominal pump replacement only. Younger age at surgery and an elevated preoperative lower-extremity modified Ashworth scale grade were associated with spinal catheter revision (p < 0.05). Catheter model type, tip location, and history of spinal fusion were not associated with obstruction. Postoperatively, SCRC patients experienced a higher rate of infection (17.1%) relative to APRC patients (0%) within 30 days from their ITB pump replacement procedure (p < 0.05) and greater likelihood of subsequent ITB system removal compared with the APRC (24.4% vs 7.4%, p < 0.05). Although not differing preoperatively, SCRC patients had lower postoperative ITB doses when compared with the APRC group (median dose 143 vs 350 µg/day, p < 0.05) at hospital discharge and remained statistically different at the 6-month and 1-year follow-ups (p < 0.05). There were no postoperative differences in baclofen overdose, withdrawal, or median number of hospital readmissions within 30 days. Overall, 31.7% of spinal catheter revisions were unanticipated by the clinical team at time of surgery. CONCLUSIONS: Younger age at surgery and increased preoperative lower-extremity tone may be risk factors for catheter obstruction, resulting in a higher rate of postoperative infection and subsequent ITB pump removal compared with pump replacement alone. Spinal catheter occlusion can complicate revision or replacement procedures, especially when unanticipated. Routine clinical assessment may be inadequate for diagnosing insidious catheter malfunction. Catheter occlusion deserves further study, and routine assessment of catheter patency may be warranted to prevent suboptimal tone therapy.