Pediatric ITB, Prevertebral BoNT Injections with Fluoroscopic Guidance (AAN 2008)

Subject: Pediatric ITB, Prevertebral BoNT Injections with Fluoroscopic Guidance (AAN 2008)

Date: 5/5/2008

E-MOVE reports from the Annual Meeting of the American Academy of Neurology, Chicago, April 14-18, 2008. Poster and platform session numbers are from Neurology 2008;70(suppl 1)

A study of intrathecal baclofen pumps in children: Experience from a tertiary care center
J Khera, D Ghosh, M Luciano
P03.008, A131

Long-term intrathecal baclofen is effective for spasticity, but complications occur in a large number of patients, according to this single-center, retrospective review.

Between 1996 and 2006, 85 patients (ages 4 to 20 years; mean 12 years) received ITB therapy. Most patients had spastic quadriplegia. Tip placement was as follows:

Cervical-T4:	7 
T5-T8:		39 
T9-lumbar:	39

Follow-up ranged from 0.5 to 120 months. Complications included:

Incision-site infection:			13 
Incision-site infection with meningitis:	4 
Isolated meningitis:				2 
Catheter displacement/disconnection:	10 
Skin erosion over pump:			8 
Catheter fracture:				4 
CSF leak:					1

Pumps were removed in 4 patients due to no improvement. One patient experienced baclofen overdose. Of 27 patients with pre-implantation scoliosis, 3 had a clinically significant increase in scoliosis at between 2 and 5 years post-implantation, and required surgery.

“Our complication rate was 25% for pump/catheter revision, and 22% for infection, which was comparable to previously published pediatric series,” the authors note. “Infection occurs earlier, and mechanical complications at any time.”

Fluoroscopic, EMG-guided, botulinum-toxin injection into the longus colli and longus capitis for the treatment of anterocollis
GA Glass, J Ostrem, S Heath, P Larson
P07.180, A387

Two patients with anterocollis and absence of aberrant EMG activity in the SCM or scalene muscles were injected with BoNT-A into the prevertebrals (longus colli and longus capitis) with the assistance of fluoroscopy and EMG guidance. Other than transient pain upon injection there were no side effects. TWSTRS scores improved more than 35%, primarily from pain decrease. Posture was not improved due to prior fusion of the cervical spine. “Injection of botulinum toxin directly into the pre-vertebral musculature is technically possible and can be safely accomplished,” the authors conclude.

E-MOVE Editor: Richard Robinson, NASW, WE MOVE

Related CME Activities - Valid for AMA PRA Category 1 Credits(s)™