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Abstract：
BACKGROUND: Spasticity can significantly affect a patient\'s quality of life, caregiver satisfaction, and the financial burden on the healthcare system. Baclofen is one of only a few options for treating spasticity. The purpose of this study is to investigate the impact of intrathecal baclofen (ITB) therapy on severe40.23 spasticity and motor function in patients with cerebral palsy.
METHODS: We conducted a systematic review in PubMed, Scopus, Ovid, and the Cochrane Library in accordance with the PRISMA guidelines. We included studies based on eligibility criteria that included desired participants (cerebral palsy patients with spasticity), interventions (intrathecal baclofen), and outcomes (the Ashworth scales and the Gross Motor Function Measure [GMFM]). The within-group Cohen\'s d standardized mean differences (SMD) were analyzed using the random effect model.
RESULTS: We screened 768 papers and included 19 in the severity of spasticity section and 6 in the motor function section. The pre-intervention average spasticity score (SD) was 3.2 (0.78), and the post-intervention average score (SD) was 1.9 (0.72), showing a 40.25% reduction. The SMD for spasticity reduction was - 1.7000 (95% CI [-2.1546; -1.2454], p-value < 0.0001), involving 343 patients with a weighted average age of 15.78 years and a weighted average baclofen dose of 289 µg/day. The SMD for the MAS and Ashworth Scale subgroups were - 1.7845 (95% CI [-2.8704; -0.6986]) and - 1.4837 (95% CI [-1.8585; -1.1088]), respectively. We found no relationship between the participants\' mean age, baclofen dose, measurement time, and the results. The pre-intervention average GMFM (SD) was 40.03 (26.01), and the post-intervention average score (SD) was 43.88 (26.18), showing a 9.62% increase. The SMD for motor function using GMFM was 0.1503 (95% CI [0.0784; 0.2223], p-value = 0.0030), involving 117 patients with a weighted average age of 13.63 and a weighted average baclofen dose of 203 µg/day. In 501 ITB implantations, 203 medical complications were reported, including six new-onset seizures (2.96% of medical complications), seven increased seizure frequency (3.45%), 33 infections (16.26%), eight meningitis (3.94%), and 16 cerebrospinal fluid leaks (7.88%). Delivery system complications, including 75 catheter and pump complications, were also reported.
CONCLUSIONS: Despite the risk of complications, ITB has a significant impact on the reduction of spasticity. A small but statistically significant improvement in motor function was also noted in a group of patients.
METHODS: We conducted a systematic review in PubMed, Scopus, Ovid, and the Cochrane Library in accordance with the PRISMA guidelines. We included studies based on eligibility criteria that included desired participants (cerebral palsy patients with spasticity), interventions (intrathecal baclofen), and outcomes (the Ashworth scales and the Gross Motor Function Measure [GMFM]). The within-group Cohen\'s d standardized mean differences (SMD) were analyzed using the random effect model.
RESULTS: We screened 768 papers and included 19 in the severity of spasticity section and 6 in the motor function section. The pre-intervention average spasticity score (SD) was 3.2 (0.78), and the post-intervention average score (SD) was 1.9 (0.72), showing a 40.25% reduction. The SMD for spasticity reduction was - 1.7000 (95% CI [-2.1546; -1.2454], p-value < 0.0001), involving 343 patients with a weighted average age of 15.78 years and a weighted average baclofen dose of 289 µg/day. The SMD for the MAS and Ashworth Scale subgroups were - 1.7845 (95% CI [-2.8704; -0.6986]) and - 1.4837 (95% CI [-1.8585; -1.1088]), respectively. We found no relationship between the participants\' mean age, baclofen dose, measurement time, and the results. The pre-intervention average GMFM (SD) was 40.03 (26.01), and the post-intervention average score (SD) was 43.88 (26.18), showing a 9.62% increase. The SMD for motor function using GMFM was 0.1503 (95% CI [0.0784; 0.2223], p-value = 0.0030), involving 117 patients with a weighted average age of 13.63 and a weighted average baclofen dose of 203 µg/day. In 501 ITB implantations, 203 medical complications were reported, including six new-onset seizures (2.96% of medical complications), seven increased seizure frequency (3.45%), 33 infections (16.26%), eight meningitis (3.94%), and 16 cerebrospinal fluid leaks (7.88%). Delivery system complications, including 75 catheter and pump complications, were also reported.
CONCLUSIONS: Despite the risk of complications, ITB has a significant impact on the reduction of spasticity. A small but statistically significant improvement in motor function was also noted in a group of patients.
摘要：
背景：痉挛会显著影响患者的生活质量，护理人员满意度，以及医疗系统的财政负担。巴氯芬是治疗痉挛的少数选择之一。这项研究的目的是研究鞘内注射巴氯芬（ITB）治疗对脑瘫患者严重40.23痉挛和运动功能的影响。
方法：我们在PubMed，Scopus,奥维德,和Cochrane图书馆符合PRISMA指南。我们纳入了基于资格标准的研究，包括所需的参与者（患有痉挛的脑瘫患者），干预措施（鞘内注射巴氯芬），和结果(阿什沃思量表和粗大运动功能测量[GMFM])。采用随机效应模型分析组内Cohen'sd标准化均差(SMD)。
结果：我们筛选了768篇论文，在痉挛严重程度部分包括19篇，在运动功能部分包括6篇。干预前平均痉挛评分(SD)为3.2(0.78),干预后平均得分(SD)为1.9(0.72)，显示减少40.25％。痉挛减轻的SMD为-1.7000(95%CI[-2.1546；-1.2454]，p值<0.0001),涉及343名患者，加权平均年龄为15.78岁，加权平均巴氯芬剂量为289µg/天。MAS和Ashworth量表亚组的SMD分别为-1.7845(95%CI[-2.8704;-0.6986])和-1.4837(95%CI[-1.8585;-1.1088])，分别。我们发现参与者的平均年龄之间没有关系，巴氯芬剂量,测量时间,和结果。干预前平均GMFM（SD）为40.03（26.01），干预后平均得分为43.88(26.18),增长9.62%。使用GMFM的运动功能的SMD为0.1503（95％CI[0.0784;0.2223]，p值=0.0030)，涉及117名患者，加权平均年龄为13.63岁，加权平均巴氯芬剂量为203µg/天。在501个ITB植入中，报告了203例医疗并发症，包括6次新发作的癫痫发作（2.96%的医疗并发症），7次癫痫发作频率增加(3.45%)，33例感染（16.26%），8例脑膜炎(3.94%),脑脊液漏16例(7.88%)。输送系统并发症,包括75例导管和泵并发症，也有报道。
结论：尽管有并发症的风险，ITB对减少痉挛有显著影响。在一组患者中，运动功能也有小幅但统计学上有显着改善。
方法：我们在PubMed，Scopus,奥维德,和Cochrane图书馆符合PRISMA指南。我们纳入了基于资格标准的研究，包括所需的参与者（患有痉挛的脑瘫患者），干预措施（鞘内注射巴氯芬），和结果(阿什沃思量表和粗大运动功能测量[GMFM])。采用随机效应模型分析组内Cohen'sd标准化均差(SMD)。
结果：我们筛选了768篇论文，在痉挛严重程度部分包括19篇，在运动功能部分包括6篇。干预前平均痉挛评分(SD)为3.2(0.78),干预后平均得分(SD)为1.9(0.72)，显示减少40.25％。痉挛减轻的SMD为-1.7000(95%CI[-2.1546；-1.2454]，p值<0.0001),涉及343名患者，加权平均年龄为15.78岁，加权平均巴氯芬剂量为289µg/天。MAS和Ashworth量表亚组的SMD分别为-1.7845(95%CI[-2.8704;-0.6986])和-1.4837(95%CI[-1.8585;-1.1088])，分别。我们发现参与者的平均年龄之间没有关系，巴氯芬剂量,测量时间,和结果。干预前平均GMFM（SD）为40.03（26.01），干预后平均得分为43.88(26.18),增长9.62%。使用GMFM的运动功能的SMD为0.1503（95％CI[0.0784;0.2223]，p值=0.0030)，涉及117名患者，加权平均年龄为13.63岁，加权平均巴氯芬剂量为203µg/天。在501个ITB植入中，报告了203例医疗并发症，包括6次新发作的癫痫发作（2.96%的医疗并发症），7次癫痫发作频率增加(3.45%)，33例感染（16.26%），8例脑膜炎(3.94%),脑脊液漏16例(7.88%)。输送系统并发症,包括75例导管和泵并发症，也有报道。
结论：尽管有并发症的风险，ITB对减少痉挛有显著影响。在一组患者中，运动功能也有小幅但统计学上有显着改善。
