Abstracts

Intrathecal baclofen has been associated with the occurrence of epileptic seizures and status epilepticus in patients with multiple sclerosis (Schuele, 2004) and traumatic head injury (Kofler, 1994). Children with cerebral palsy (CP) are at increased risk for epileptic seizures and a recent study in 54 children with CP reported the new onset of seizures in 14% of children after initiation of oral baclofen therapy (Hansel, 2003). The goal of our study was to investigate the effect of intrathecal baclofen (ITB) therapy on seizure frequency in children with CP. Data were obtained from the Pediatric Neurosurgery ITB database. The database contains records of all patients since 1996 with a diagnosis of CP who had an ITB pump implanted for the treatment of spasticity or dystonia. Patient who had no follow-up at our institution after the implantation were excluded (n=5). Forty-two consecutive children, 30 male and 12 female, underwent implantation of a baclofen pump between 1996 and 2003 and were subsequently followed for a median of 38 months (range 5 to 89 months). Mean age at pump implantation was 10.8 years. Fourteen patients (33%) had a diagnosis of epilepsy prior to pump implantation with a median seizure frequency of 2 per year ([lt]1/year to 5/day). Two patients had new events after initiation of ITB therapy: an 8 year old boy had an isolated seizure in the context of a febrile illness and a 9 year old girl with a past history of neonatal convulsions had two unprovoked seizures 6 and 11 months after pump implantation. These events were felt to be unrelated to the ITB therapy. No new seizure or increase in seizure frequency was seen in the remaining patients. In our series of 42 children with cerebral palsy treated with intrathecal baclofen, we did not observe an increase in seizure frequency during a observation period of three and a half years. In patients with cerebral palsy, intrathecal baclofen does not appear to increase the risk of seizures as compared to oral baclofen.