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A retrospective chart review of acute intrathecal baclofen (ITB) withdrawal and a description of its outcomes
Author(s) -
M GORMLEY
Publication year - 2015
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.26_12886
Subject(s) - baclofen , chart , medicine , intrathecal , retrospective cohort study , anesthesia , psychology , surgery , mathematics , statistics , receptor , agonist
Background/Objectives: Cerebral palsy (CP) is one of the most common congenital disorders in children affecting approximately 2–3 infants per 1000 births. Of the children diagnosed with cerebral palsy, hemiplegic cerebral palsy is the most prevalent, occurring in 20–30% of children with CP. Children with hemiplegic cerebral palsy often have a limb length discrepancy with the leg on the involved side being shorter than the leg on the uninvolved side. However, conclusive research has not been conducted to verify this assumption. This study assesses the leg lengths in children with hemiplegic CP and determines if there is a length discrepancy and, if present, if the discrepancy changes as the child ages. Knowledge about the changes in leg length over time of children with a discrepancy should help physicians with long-term management. Study Design: A retrospective cohort study. Study Participants and Setting: Children with hemiplegic CP treated at a large pediatric rehabilitation hospital. Materials/Methods: The medical records of 54 patients, 26 females and 28 males with hemiplegic cerebral palsy were reviewed. Patients whose limb lengths were measured using scanograms and had no previous bony or soft tissue surgeries were included in the study. Nine of the 54 patients (16.6%) had serial scanograms. A matched paired t-test was used to evaluate the data. Results: Of these 54 patients, 23 had left-sided hemiplegia and 31 had right-sided hemiplegia. The leg on the involved side was shorter than the leg on the uninvolved side in 53 patients (98.1%). The range of the initial leg length differences varied from 0 to 2.5 cm. In the 54 patients, the involved side was shorter by an average of 1.17 cm, (SD .607 cm, p-value of 5.15*10–20). Of the 9 patients that had serial scanograms, the absolute value of difference in limb length tended to initially increase as the child aged, but the discrepancies decreased between the approximate ages of 11–13 years. In addition, 2 patients whose involved limb was initially shorter than the uninvolved side had growth in their involved limbs to the point that their involved limb ultimately became longer than their uninvolved limb. Conclusions/Significance: The leg length on the involved side of a child with hemiplegic CP is significantly shorter than the leg on the uninvolved side. This limb length discrepancy decreases over time, especially between approximately 11–13 years of age. Physicians who treat children with hemiplegic CP should consider this self-correction of the leg length discrepancy when determining appropriate treatment for these children. SP27 A retrospective chart review of acute intrathecal baclofen (ITB) withdrawal and a description of its outcomes