Cerebral Palsy Clinical Trial
Official title:
Intrathecal Baclofen. Evaluation of a Therapy for Refractory Spasticity in Children With Cerebral Palsy
The objective of this study is to determine the efficacy and safety of treatment with intrathecal baclofen for severe spasticity in children with cerebral palsy.
Spasticity in cerebral palsy (CP) is a serious problem leading to pain, sleep disturbance,
increased expenditure of energy and/or interference with positioning, transfers, dressing
and body hygiene. In later stages, secondary phenomena, such as contractures, decubitus and
heterotopic calcifications of joints or tendons may create large treatment problems. A
substantial group of children with severe CP does not respond to regular treatments, such as
physical therapy, orthopaedic surgery or oral medication. An effective treatment option for
intractable spasticity is the continuous delivery of intrathecal baclofen (CITB). In 2000,
the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) published a
systematic review on the body of evidence about intrathecal baclofen (ITB) for spasticity in
individuals with CP. It appeared that only a small and uncertain number of children had been
studied. Except for two case-reports, none of the studies solely concerned children. The
research methodology employed in three quarters of the available studies was not capable of
confirming treatment effect. The AACPDM underlined the need for further high-level research
in the form of prospective, randomized trials that use valid and reliable outcome measures
in well described and homogeneous groups.
In 1998 the Dutch Study Group on Child Spasticity designed the Dutch national study on the
effectiveness and safety of ITB for refractory spasticity in children with cerebral palsy.
The Dutch national ITB study included four phases: 1] the selection phase, 2] the
double-blind, placebo-controlled dose-escalation test treatment phase, 3] the prospective,
randomized, open-label implantation phase and 4] the follow-up phase.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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