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Access to Intrathecal Baclofen Treatment for Children with Cerebral Palsy in European Countries: An SCPE Survey Reveals Important DifferencesAcknowledgments This study was performed on behalf of the SCPE collaboration and was funded by the European Union Health Program—Grant Number DG SANCO EAHC 2008 1307—“Surveillance of Cerebral Palsy in Europe: best practice in monitoring, understanding of inequality, and dissemination of knowledge.”
We are grateful to all centers across Europe contributing data to this study.
Medtronic, Tricumed, and Codman manufacturers of medical pumps used for intrathecal baclofen treatment, provided information regarding availability of treatment in European countries.
16 April 2019
09 December 2019
02 March 2020 (online)
Aim The aim is to study access to intrathecal baclofen (ITB) for children with cerebral palsy (CP) in Europe, as an indicator of access to advanced care.
Methods Surveys were sent to CP registers, clinical networks, and pump manufacturers. Enquiries were made about ITB treatment in children born in 1990 to 2005 by sex, CP type, level of gross motor function classification system (GMFCS) and age at the start of treatment. Access to ITB was related to the country's gross domestic product (GDP) and % GDP spent on health.
Results In 2011 population-based data from Sweden, Norway, England, Portugal, Slovenia, and Denmark showed that 114 (3.4%) of 3,398 children with CP were treated with ITB, varying from 0.4 to 4.7% between centers. The majority of the children were at GMFCS levels IV-V and had bilateral spastic CP. In Sweden, dyskinetic CP was the most commonly treated subtype. Boys were more often treated with ITB than girls (p = 0.014). ITB was reported to be available for children with CP in 25 of 43 countries. Access to ITB was associated with a higher GDP and %GDP spent on health (p < 0.01). Updated information from 2019 showed remaining differences between countries in ITB treatment and sex difference in treated children was maintained.
Conclusion There is a significant difference in access to ITB for children with CP across Europe. More boys than girls are treated. Access to ITB for children with CP is associated with GDP and percent of GDP spent on health in the country.
- 1 Hägglund G, Andersson S, Düppe H, Lauge-Pedersen H, Nordmark E, Westbom L. Prevention of severe contractures might replace multilevel surgery in cerebral palsy: results of a population-based health care programme and new techniques to reduce spasticity. J Pediatr Orthop B 2005; 14 (04) 269-273
- 2 Dickinson HO, Parkinson KN, Ravens-Sieberer U. , et al. Self-reported quality of life of 8-12-year-old children with cerebral palsy: a cross-sectional European study. Lancet 2007; 369 (9580): 2171-2178
- 3 Albright AL, Cervi A, Singletary J. Intrathecal baclofen for spasticity in cerebral palsy. JAMA 1991; 265 (11) 1418-1422
- 4 Albright AL, Barry MJ, Painter MJ, Shultz B. Infusion of intrathecal baclofen for generalized dystonia in cerebral palsy. J Neurosurg 1998; 88 (01) 73-76
- 5 Motta F, Stignani C, Antonello CE. Effect of intrathecal baclofen on dystonia in children with cerebral palsy and the use of functional scales. J Pediatr Orthop 2008; 28 (02) 213-217
- 6 de Lissovoy G, Matza LS, Green H, Werner M, Edgar T. Cost-effectiveness of intrathecal baclofen therapy for the treatment of severe spasticity associated with cerebral palsy. J Child Neurol 2007; 22 (01) 49-59
- 7 Saulino M, Guillemette S, Leier J, Hinnenthal J. Medical cost impact of intrathecal baclofen therapy for severe spasticity. Neuromodulation 2015; 18 (02) 141-149 , discussion 149
- 8 Campbell WM, Ferrel A, McLaughlin JF. , et al. Long-term safety and efficacy of continuous intrathecal baclofen. Dev Med Child Neurol 2002; 44 (10) 660-665
- 9 Vles GF, Soudant DL, Hoving MA. , et al. Long-term follow-up on continuous intrathecal Baclofen therapy in non-ambulant children with intractable spastic cerebral palsy. Eur J Paediatr Neurol 2013; 17 (06) 639-644
- 10 Bonouvrié LA, Becher JG, Vles JSH, Vermeulen RJ, Buizer AI. ; IDYS Study Group. The effect of intrathecal baclofen in dyskinetic cerebral palsy: the IDYS trial. Ann Neurol 2019; 86 (01) 79-90
- 11 Surveillance of Cerebral Palsy in Europe. Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Dev Med Child Neurol 2000; 42 (12) 816-824
- 12 Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39 (04) 214-223
- 13 CIA. The World Factbook. 2008 . Available at: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2004rank.html . Accessed April 22, 2012
- 14 Novak I, McIntyre S, Morgan C. , et al. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol 2013; 55 (10) 885-910
- 15 Dan B, Motta F, Vles JS. , et al. Consensus on the appropriate use of intrathecal baclofen (ITB) therapy in paediatric spasticity. Eur J Paediatr Neurol 2010; 14 (01) 19-28
- 16 Berweck S, Lütjen S, Voss W. , et al; ITB Working Party. Use of intrathecal baclofen in children and adolescents: interdisciplinary consensus table 2013. Neuropediatrics 2014; 45 (05) 294-308
- 17 Eek MN, Olsson K, Lindh K. , et al. Intrathecal baclofen in dyskinetic cerebral palsy: effects on function and activity. Dev Med Child Neurol 2018; 60 (01) 94-99
- 18 Sellier E, Surman G, Himmelmann K. , et al. Trends in prevalence of cerebral palsy in children born with a birthweight of 2,500 g or over in Europe from 1980 to 1998. Eur J Epidemiol 2010; 25 (09) 635-642
- 19 Gough M, Shafafy R, Shortland AP. Does sex influence outcome in ambulant children with bilateral spastic cerebral palsy?. Dev Med Child Neurol 2008; 50 (09) 702-705
- 20 Zwick EB, Svehlík M, Kraus T, Steinwender G, Linhart WE. Does gender influence the long-term outcome of single-event multilevel surgery in spastic cerebral palsy?. J Pediatr Orthop B 2012; 21 (05) 448-451
- 21 Franzén M, Hägglund G, Alriksson-Schmidt A. Treatment with Botulinum toxin A in a total population of children with cerebral palsy—a retrospective cohort registry study. BMC Musculoskelet Disord 2017; 18 (01) 520
- 22 Degerstedt F, Wiklund M, Enberg B. Physiotherapeutic interventions and physical activity for children in Northern Sweden with cerebral palsy: a register study from equity and gender perspectives. Glob Health Action 2016; 10 (Suppl. 02) 1272236
- 23 Parkinson KN, Dickinson HO, Arnaud C, Lyons A, Colver A. ; SPARCLE group. Pain in young people aged 13 to 17 years with cerebral palsy: cross-sectional, multicentre European study. Arch Dis Child 2013; 98 (06) 434-440
- 24 Romeo DM, Sini F, Brogna C, Albamonte E, Ricci D, Mercuri E. Sex differences in cerebral palsy on neuromotor outcome: a critical review. Dev Med Child Neurol 2016; 58 (08) 809-813
- 25 Berman CM, Eppinger MA, Mazzola CA. Understanding the reasons for delayed referral for intrathecal baclofen therapy in pediatric patients with severe spasticity. Childs Nerv Syst 2015; 31 (03) 405-413