Baclofen for the Treatment of Spasticity and Dystonia in Cerebral Palsy

Movement disorders in childhood, notably cerebral palsy (CP), stem largely from brain dysfunction during development, manifesting as non-progressive deficits. CP encompasses various movement- and posture-related disorders, often accompanied by cognitive, behavioral, and sensory disruptions, as well as epilepsy and musculoskeletal issues. The CP classification is gauged by the severity of motor function impairment and the dominant movement disorder type. Spasticity, the most common CP type, involves increased muscle resistance caused by central nervous system lesions. Dyskinetic CP, the second most prevalent form, features involuntary movements and fluctuating muscle tone. Treatment of disabling movement disorders such as spasticity or dyskinesia in children is challenging. Oral pharmacological treatment options, including oral baclofen, are often insufficient and/or cause side effects. Intrathecal (IT) baclofen treatment represents a therapeutic option for some of these patients. There is some evidence, mostly provided by single-bolus randomized trials, of the effectiveness of IT baclofen in the treatment of spasticity in children with spastic CP at the level of body functions and structures (spasticity). However, a low level of evidence of the effectiveness of continuous IT baclofen, particularly with regard to activities/participation, has been reported. One randomized controlled trial (RCT) and related follow-up study reported evidence of the effect of IT baclofen treatment on dystonia in children with dyskinetic CP, including attainment of individual goals. However, other studies yielding similar results provide lower levels of evidence. Despite the reported levels of evidence, there are frequently no alternative treatment options for these children; therefore, when all other options fail, IT baclofen should be considered. Future studies should be conducted to specifically investigate outcome measures at the level of activities and participation.