Effectiveness of Oral Baclofen in the Treatment of Spasticity in Children and Adolescents With Cerebral Palsy

• Published in: Archives of physical medicine and rehabilitation Vol. 97; no. 4; pp. 604 - 618
• Main Authors: Navarrete-Opazo, Angela A., MD, PhD, Gonzalez, Waleska, MD, Nahuelhual, Paula, PT
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2016
• Subjects: Adolescent; Baclofen; Baclofen - therapeutic use; Cerebral palsy; Cerebral Palsy - drug therapy; Child; Child, Preschool; Disabled children; Female; Humans; Male; Muscle Relaxants, Central - therapeutic use; Muscle spasticity; Muscle Spasticity - drug therapy; Physical Medicine and Rehabilitation; Randomized Controlled Trials as Topic; Rehabilitation; Treatment Outcome; Cerebral palsy; Ashworth Scale; Gross Motor Function Classification System; AE; Disabled children; Modified Ashworth Scale; Goal Attainment Scaling; CP; intrathecal baclofen; AS; adverse effect; Pediatric Evaluation of Disability Inventory; ITB; Baclofen; GAS; Rehabilitation; GMFCS; Muscle spasticity; MAS; PEDI
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2015.08.417

Abstract Objective To systematically review the effectiveness of oral baclofen versus placebo or other antispastic oral medications in terms of body function, level of activity, and quality of life in children and adolescents with spastic cerebral palsy who are younger than 18 years. Data Sources Cochrane Library, Health Science Databases, DARE, LILACS, Embase, MEDLINE, OTseeker, PEDro, PsycINFO, SpeechBITE, ScienceDirect, Scopus, Trip, ClinicalTrials.gov , Google Scholar, OpenGrey, and manual search. Study Selection Randomized or not randomized controlled trials and cohort studies comparing the effect of any dosage of oral baclofen with that of no treatment, placebo, or another antispastic medication in children and adolescents with spastic cerebral palsy were selected. Data Extraction Following the Cochrane Handbook for Systematic Reviews of Interventions guidelines, 2 reviewers independently searched articles in databases from their inceptions until October 2014. Data Synthesis Six randomized controlled trials involving a total of 130 patients were selected. Studies show a great variability in motor classification, dosage of baclofen, and outcome measures. There is conflicting evidence on the effectiveness of oral baclofen in reducing muscle tone or improving motor function or the level of activity. The overall methodological quality of the studies was low. The main qualitative limitations of the studies correspond to serious risk of bias, inconsistency of results, unpowered sample size, and publication bias. Conclusions There are insufficient data to support or refute the use of oral baclofen for reducing spasticity or improving motor function in children and adolescents with spastic cerebral palsy.