scholarly journals Intrathecal baclofen pump infections in a pediatric population from 1998-2014

2015 ◽  
Vol 57 ◽  
pp. 77-77
Keyword(s):  
Pediatric Population ◽  
Intrathecal Baclofen

Poster 383 Urologic Adverse Effects of Intrathecal Baclofen Therapy in a Pediatric Population: Review of Case Series

PM&R ◽  
2011 ◽  
Vol 3 ◽  
pp. S307-S307
Author(s):  
Maura McManus ◽  
Ahmad Bani-Hani ◽  
Sharon Lyons ◽  
Nicole Marcantuono ◽  
Susan Myers
Keyword(s):  
Adverse Effects ◽  
Pediatric Population ◽  
Case Series ◽  
Intrathecal Baclofen ◽  
Intrathecal Baclofen Therapy

Paradoxical reaction to increased doses of intrathecal baclofen in a patient with Leigh syndrome

2021 ◽  
Vol 14 (1) ◽  
pp. 121-125
Author(s):  
Fareea Khaliq ◽  
Christina Santia ◽  
Erika Erlandson
Keyword(s):  
Genetic Disease ◽  
Pediatric Population ◽  
Leigh Syndrome ◽  
Intrathecal Baclofen ◽  
Paradoxical Reaction ◽  
First Case ◽  
Paradoxical Worsening ◽  
Initial Improvement ◽  
Initial Placement ◽  
Incremental Increase

In clinical practice, intrathecal baclofen (ITB) therapy is used to control spasticity. After initial placement of the ITB pump, clinicians incrementally increase the dose until effectiveness in alleviating spasms and spasticity is optimized. However, this case describes a 4-year-old male with Leigh syndrome who developed a paradoxical worsening of spasticity and pain with incremental increase of his ITB pump. In this rare genetic disease with a poor prognosis, an ITB pump was trialed and implanted and titrated upwards with initial improvement. However, his spasticity and pain then began to worsen with each dosage increase. Subsequently, his symptoms improved significantly when the dose was weaned. This is the first case that describes this paradoxical reaction in a pediatric population and discusses recommendations about how clinicians should safely titrate the pump for patient care.

Subfascial Implantation of Intrathecal Baclofen Pumps in Children: Technical Note

Neurosurgery ◽  
2001 ◽  
Vol 49 (3) ◽  
pp. 753-757 ◽  
Author(s):  
Brian Harris Kopell ◽  
Debra Sala ◽  
Werner K. Doyle ◽  
David S. Feldman ◽  
Jeffrey H. Wisoff ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Pediatric Population ◽  
Intrathecal Baclofen ◽  
Implantation Site ◽  
Implantation Technique ◽  
Soft Tissue Coverage ◽  
Tissue Mass ◽  
Intrathecal Baclofen Therapy ◽  
Skin Breakdown

Abstract OBJECTIVE Indwelling intrathecal drug delivery systems are becoming increasingly important as a method of neuromodulation within the nervous system. In particular, intrathecal baclofen therapy has shown efficacy and safety in the management of spasticity and dystonia in children. The most common complications leading to explantation of the pumps are skin breakdown and infection at the pump implantation site. The pediatric population poses particular challenges with regard to these complications because appropriate candidates for intrathecal baclofen therapy are often undernourished and thus have a dearth of soft tissue mass to cover a subcutaneously implanted baclofen pump. We report a technique of subfascial implantation that provides greater soft tissue coverage of the pump, thereby reducing the potential for skin breakdown and improving the cosmetic appearance of the implantation site. METHODS Eighteen consecutively treated children (average age, 8 yr, 7 mo) with spasticity and/or dystonia underwent subfascial implantation of a baclofen pump. These children's mean weight of 42.9 lb is less than the expected weight for a group of children in this age group, ranging from 4 years, 8 months, to 15 years, 7 months. In all patients, the pump was inserted into a pocket surgically constructed between the rectus abdominus and the external oblique muscles and the respective anterior fascial layers. RESULTS At an average follow-up of 13.7 months, no infection or skin breakdown had occurred at the pump surgical site in any of the 18 patients. CONCLUSION At this early follow-up, the subfascial implantation technique was associated with a reduced rate of local wound and pump infections and provided optimal cosmetic results as compared with that observed in retrospective cases.

scholarly journals Botulinum Neurotoxin Injections in Childhood Opisthotonus

Toxins ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 137 ◽  
Author(s):  
Mariam Hull ◽  
Mered Parnes ◽  
Joseph Jankovic
Keyword(s):  
Quality Of Life ◽  
Botulinum Neurotoxin ◽  
Pediatric Population ◽  
Symptom Relief ◽  
Intrathecal Baclofen ◽  
Paraspinal Muscles ◽  
Hypoxic Injury ◽  
Abnormal Posture ◽  
Deep Brain

Opisthotonus refers to abnormal axial extension and arching of the trunk produced by excessive contractions of the paraspinal muscles. In childhood, the abnormal posture is most often related to dystonia in the setting of hypoxic injury or a number of other acquired and genetic etiologies. The condition is often painful, interferes with ambulation and quality of life, and is challenging to treat. Therapeutic options include oral benzodiazepines, oral and intrathecal baclofen, botulinum neurotoxin injections, and deep brain stimulation. Management of opisthotonus within the pediatric population has not been systematically reviewed. Here, we describe a series of seven children who presented to our institution with opisthotonus in whom symptom relief was achieved following administration of botulinum neurotoxin injections.

Poster 434 Intrathecal Baclofen Therapy: Simple Continuous vs. Flex Mode Dosing in the Pediatric Population

PM&R ◽  
2012 ◽  
Vol 4 ◽  
pp. S339-S340
Author(s):  
Elizabeth Poplawski ◽  
William Boydston ◽  
Elaine Mininger ◽  
Melissa Nalder ◽  
Maurice Sholas ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Intrathecal Baclofen ◽  
Intrathecal Baclofen Therapy

scholarly journals Rising Complication Rates after Intrathecal Catheter and Pump Placement in the Pediatric Population: Analysis of National Data Between 1997 and 2006

2012 ◽  
Vol 1;15 (1;1) ◽  
pp. 65-74
Author(s):  
Dr. Zhiyi Zuo
Keyword(s):  
Population Analysis ◽  
Pediatric Population ◽  
National Sample ◽  
Intrathecal Baclofen ◽  
Complication Rates ◽  
Intrathecal Catheter ◽  
Hospital Size ◽  
Mechanical Complications ◽  
Relative Contribution ◽  
Pump Placement

Background: Intrathecal delivery of baclofen (ITB) is effective at controlling spasticity. However, it requires the placement of a catheter into the intrathecal space, and a pump with a reservoir for the medication. The process of placing the catheter and pump are prone to complications. Objectives: The objective of this paper is to determine factors contributing to rising complication rates after intrathecal catheter/pump placement in a national sample of pediatric patients. Study Design: This was a retrospective observational database study. Methods: We queried the Kids’ Inpatient Database for all children greater than 4 years old and under 20 years old for the years 1997, 2000, 2003, and 2006 who had an intrathecal catheter and pump placed. We then compared demographics and hospital characteristics of patients with and without complications. We performed univariate and multivariate analyses to determine the relative contribution of various factors to the development of complications. Results: We identified 2,843 patients who met our criteria, and 514 of these patients had one or more complications after placement of intrathecal pump/catheter. There were 1.14 complications per patient. The complication rate was 10.2% in 1997, and increased to 21.9% in 2006. Mechanical complications were the most common type of complication in this population, account for nearly two-thirds of all complications occurring. Age, hospital type, hospital size, and admission source were independent predictors of complications. Limitations: We did not have access to ASA status, operative details, and access to patient charts. Conclusions: Complication rates after placement of intrathecal pump/catheters have increased in the pediatric population between 1997 and 2006 mainly due to an increase in mechanical complications. Key words: Intrathecal, baclofen, catheter, pediatric, kids, complications, spasticity

A standardized protocol to reduce pediatric baclofen pump infections: a quality improvement initiative

2018 ◽  
Vol 21 (4) ◽  
pp. 395-400 ◽  
Author(s):  
Virendra R. Desai ◽  
Jeffrey S. Raskin ◽  
Arvind Mohan ◽  
JoWinsyl Montojo ◽  
Valentina Briceño ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Relative Risk ◽  
Infection Prevention ◽  
Pediatric Population ◽  
Compliance Rate ◽  
Intrathecal Baclofen ◽  
Quality Improvement Initiative ◽  
Complication Rates ◽  
Improvement Project ◽  
The Absolute

OBJECTIVEIntrathecal baclofen pumps are generally placed in children for the treatment of spasticity and dystonia. Use of implants in this pediatric population with comorbidities is reported to have a high risk of complications and infections. With the aim of reducing baclofen pump–related infections, a quality improvement project was instituted at the authors’ institution.METHODSA workflow paradigm unique to baclofen pump implantation aimed at decreasing implant-related infections was implemented. All baclofen pump operations performed at the authors’ institution between August 2012 and June 2016 were reviewed. An infection prevention protocol was created and implemented in August 2014 based on a literature review and the consensus opinion of the pediatric neurosurgeons in the group. Compliance with the prevention bundle was tracked. Case outcomes before and after implementation of the protocol with a minimum of 3 months of follow-up were retrospectively reviewed. Univariate and multivariate analyses were performed to assess the association of the steps in the prevention bundle with infection and complication outcomes.RESULTSA total of 128 baclofen pump surgeries were performed (64 preprotocol and 64 postprotocol). The patient age range was 3 to 27 years. The overall compliance rate with the infection prevention bundle was 82%. The pre- and postimplementation infection rates were 12.5% and 6.3%, respectively (p = 0.225). The total pre- and postimplementation complication rates were 23.4% and 9.4%, respectively (p = 0.032). The absolute and relative risk reductions for infections were 6.3% (95% CI 3.8%–16.3%) and 50%, respectively; for complications, the absolute and relative risk reductions were 14.1% (95% CI 1.5%–26.7%) and 60%, respectively.CONCLUSIONSThe total complication rate following intrathecal baclofen pump surgery was significantly lower after implementation of the quality improvement protocol. This study is an example of using checklist standardization to diminish special cause variability.

Infectious Complications of Intrathecal Baclofen Pump Devices in a Pediatric Population

2013 ◽  
Vol 32 (7) ◽  
pp. 715-722 ◽  
Author(s):  
Michelle P. Dickey ◽  
Marilyn Rice ◽  
Douglas G. Kinnett ◽  
Robin Lambert ◽  
Stephanie Donauer ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Intrathecal Baclofen ◽  
Infectious Complications

Use of Vestibular Rehabilitation in the Pediatric Population

2019 ◽  
Vol 4 (6) ◽  
pp. 1399-1405 ◽  
Author(s):  
Jennifer Christy
Keyword(s):  
Pediatric Population ◽  
Dynamic Balance ◽  
Vestibular Rehabilitation ◽  
Rehabilitation Program ◽  
Gross Motor ◽  
Gaze Stabilization ◽  
Motor Delay ◽  
Rehabilitation Programs ◽  
Motor Practice ◽  
Balance Exercises

Purpose The purpose of this article was to provide a perspective on vestibular rehabilitation for children. Conclusion The developing child with vestibular dysfunction may present with a progressive gross motor delay, sensory disorganization for postural control, gaze instability, and poor perception of motion and verticality. It is important that vestibular-related impairments be identified early in infancy or childhood so that evidence-based interventions can be initiated. A focused and custom vestibular rehabilitation program can improve vestibular-related impairments, enabling participation. Depending on the child's age, diagnosis, severity, and quality of impairments, vestibular rehabilitation programs may consist of gaze stabilization exercises, static and dynamic balance exercises, gross motor practice, and/or habituation exercises. Exercises must be modified for children, done daily at home, and incorporated into the daily life situation.

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