Baclofen Treatment for Pain in Non-functional Children with Cerebral Palsy –A Brief Report Hilla Ben-Pazi 1 *, Gila Ben-Shimol 2 , Ruth David 2 , Adi Aran 3 and Natali Dechtiar 2 1 Pediatric Movement Disorders, Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel 2 Aleh nursery home, Jerusalem, Israel 3 Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel * Corrsponding Autor: Ben-Pazi H, Pediatric Movement Disorders, Neuropediatric Unit, Shaare Zedek Medical Center POB 3235, Jerusalem 91031, Israel, Tel: 9722-6555345; Fax: 9722-6555672; E-mail: benpazi@gmail.com Rec date: January 7, 2016; Acc date: March 5, 2016; Pub date: March 14, 2016 Copyright: © 2016 Ben-Pazi H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Baclofen, a GABA-B agonist, reduces hypertonia by increasing spinal inhibition and improves motor function in functional children with cerebral palsy. We hypothesized that oral baclofen reduces pain and improves daily care in nonfunctional children with spastic cerebral palsy. To test this children residing in nursery homes with hypertonia causing pain or interfering with daily care were enrolled in this randomized, double blind, placebo controlled, crossover pilot study. Participants were examined before, during and after 13 weeks of baclofen (2 mg/kg/day) and placebo for pain (Brief Pain Inventory and Dalhousie Pain Survey), ease of care (care and comfort questionnaire) and overall treatment assessment (specific questionnaire, designed for this study). Two participants completed this pilot (ages 7 and 8 years). Pain was reported to interfere less on peak dose of baclofen treatment compared to placebo in one child (p=0.0001) and care tended to be easier in the other (p=0.05). Blinded caregivers recommended continuing baclofen. No significant side effects were reported. Baclofen, an inexpensive safe medication, may alleviate pain in nonfunctional spastic children. Keywords: Brief Pain Inventory and Dalhousie Pain Survey; Care and comfort questionnaire; Hypertonia; Range of motion; Nursery home Introduction Recurrent and chronic pain of moderate intensity has been documented in most children sufering from cerebral palsy (CP,) the common cause of disability in children (2:1000 live births). Te spastic, hypertonic element of this congenital motor disorder may be one an important source of pain. 70% of children with CP experience recurrent chronic pain of moderate intensity on a daily or weekly basis [1,2]. Physiotherapy required on a daily basis involves painful exercises and may be limited by pain. Pain evaluation in children is generally based on childrens' report or parents' impression. However, in severely disabled children with limited communication, pain assessment is challenging. Difculty in pain evaluation may lead to underestimation of pain resulting in under or over treatment. However, in these children with hypertonia and limited communication one may estimate pain indirectly by ease of daily care and child's comfort. Baclofen, a GABA-B receptor agonist, is one of few medications reducing hypertonia in CP [3]. Oral baclofen was found efective in improving daily function in children with CP in a randomized double blind study [4] and Intrathecal baclofen has been shown to alleviate pain in 50% of patients thus improving daily care and communication in severely afected children [5]. Nevertheless need for baclofen treatment, its efcacy and impact on daily life in nonfunctional children with CP has not been studied. Oral baclofen treatment is safer and cheaper than intrathecal administration; however, its impact on hypertonia related pain has not been formally evaluated in nonfunctional children with CP. Te goal of this study was to assess efectiveness of oral baclofen in reducing pain and improving daily care in nonfunctional hypertonic children with CP. To test this we started a prospective double blind randomized crossover pilot. Case report Participants: Children from nursery homes who were nonfunctional (Gross-Motor-Function-Classifcation-System level 5) and sufered from hypertonia that caused pain or difculty in daily care were enrolled (n=3) and completed (n=2) the study: Child #1, a 7-year-old girl was born afer 34 weeks of gestation with low apgar scores (6 at 5 minutes). Her MRI demonstrated difuse extensive encephelomalacia. Parents were second degree cousins; infectious, genetic and metabolic workup was negative. She was blind with no voluntary movements but occasionally reacted to her name. Seizures were treated with lamotrigene. On examination she smiled occasionally and initiated random vocalization. She had some dystonia in her upper limbs. Spasticity was most prominent in lower limbs with a positive Babinsky sign and clonus. Treatment with levodopa was inefective. Child #2, an 8-year-old boy, was born afer 32 weeks of gestation, to non-consanguineous parents. He had non-progressive spastic quadriplegia due to an unknown cause. He did not have any voluntary movements or any apparent communication. During examination he tended to fxate his gaze to the right with intermittent nystagmus. Dystonic hand posture increased when excited. He had generalized spasticity hyperactive deep tendon refexes and Babinski sign was negative. Child #3, a 7.5-year-old boy, was resuscitated following a domestic accident at infancy. Seizures were treated with Phenobarbital. His only Ben-Pazi H, et al, J Pediatr Neurol Med 216, 1:2 DOI: 10.4172/2472-100x.1000108 Case Report Open Access J Pediatr Neurol Med, an open access journal ISSN:2472-100x Volume 1 • Issue 2 • 108 J o u r n a l o f P e d i a t r i c N e u r o l o g y a n d M e d i c i n e ISSN: 2472-100X Journal of Pediatric Neurology & Medicine