A review of the complications of intrathecal baclofen in patients with cerebral palsy

Intrathecal baclofen (ITB) has become a standard treatment for spasticity in patients with cerebral palsy (CP) over the last ten years. This review summarizes and assesses the evidence for the safety of ITB in patients with CP. The literature was searched using electronic databases and reference lists from March 2000 through April 2007. There were 36 studies identified reporting on the complications of ITB in patients with CP in non-controlled case series or single case reports; about half of these report only on the issue of complications, while the other half report on treatment effects as well. The majority of the participants reported on in these studies are in the pediatric or adolescent age range, but many studies include some adult patients with CP as well as a minority of patients with diagnoses other than CP. Conclusions on the basis of these disparate studies are limited; however, the available literature suggests that a relatively high rate of complications is associated with ITB treatment and that certain complications are associated with significant morbidity. Children appear to be at higher risk for complications than adults. However, until we have consistent, reliable reports of complications, it will not be possible to perform specific risk/benefit analyses. Recommendations for improving investigation in this important area are discussed.