[Quality of life in cerebral palsy children treated with intrathecal baclofen pump implantation in parents' opinion].

Abstract

Introduction: Most common disorder in patients with cerebral palsy (CP) is spasticity. It is a result of non-progressing damage of Upper Motor Neuron system, causing imbalance signals, and consequently increasing muscle activity. Spasticity decreased activity of daily living of the patient and their caregivers. It may cause many medical and social problems. Baclofen is a synthetic analog of gamma-aminobutryacid, admistrated in intrathecal space by pump. It inhibits both monosynaptical and polisynaptical spinal reflexes. First time baclofen pump (ITB) were applied by Penn and Kroin in 1984 to treat spasticity. ITB is indicated in severe children cerebral palsy, especially in tetraparesis. The purpose of this study is attempt for objective and subjective evaluation of the quality of life after implantation of ITB.

Material and methods: In this research data of 161 children were analyzed with spastic tetraparesis (GMFCS V). Evaluation was based on an analysis of the quantity of additional surgical procedures before and after ITB implantation. Subjective assessment was made using questionnaires addressed to parents on fundamental aspects of everyday activities and quality of life after implantation of ITB. RESULTS. The average age AT the time of surgery was 12 year and 2 months (SD 4.7). The average follow up was 3 years and 2 months (SD 2.4). During ITB implantation additional surgical procedure were performed in 43% of Children. During the next scheduled ITB pump exchange indication to addictional surgical procedure was reduced to 20%. The average questionnaire score was 13 points (0-16 max.). Fifty eight percents of caregivers of children who had any kind of device related complication scored with average score 13.5.

Conclusion: 1) ITB implantation in the treatment of children with severe CP improves their quality of life. 2) Indication to perform surgical procedures were reduced in patients treated with ITB. 3) ITB implantation correlates with the high level of caregivers satisfaction as the potential for improvements, however one have to think about the complication.