Intrathecal Baclofen Therapy in Children: Testing, Dose-Finding, and Complications—A Single-Center Experience

BACKGROUND: Intrathecal administration of Baclofen, a γ-aminobutyric acid agonist, is an established treatment for spasticity in both pediatric and adult populations, resulting in functional improvements in daily activities. Treatment optimization requires multiple, gradual dose adjustments to achieve the optimal dose for each patient, tailored to individualized goals and the specific pathology. METHODS: We conducted a retrospective review of our experience from August 2021 to December 2024. A total of 43 pediatric patients were implanted with an intrathecal Baclofen pump. We analyzed the test dose, the dose-finding process and the complications we experienced. Subsequently, we conducted a subgroup analysis to identify any statistically significant differences between subgroups. RESULTS: Thirty-five patients underwent a bolus via lumbar puncture, while in 6 cases via a subcutaneous reservoir. The average dose at the implantation was 69 mcg of baclofen/day ± 37 mcg/day, with an average dose change during the follow-up of +52% ± 79%. The cumulative revision rates were 6.9%, 7.7%, and 11.8% at 30 days, 3 months, and 6 months, respectively. No statistically significant differences between subgroups were found. CONCLUSIONS: The dose-finding requires a long and multistep process. The high interindividual variability highlights the need for a highly personalized approach to dose titration.