AUDIT ON THE USE OF ORAL BACLOFEN IN CHILDREN WITH CEREBRAL PALSY ATTENDING WARRINGTON CDC

1
AUDIT ON THE USE OF ORAL BACLOFEN IN CHILDREN
WITH CEREBRAL PALSY ATTENDING WARRINGTON CDC

• Dr B George

2
Aim

• To identify various factors affecting usage.
• To identify existing regimes of prescription.
• To document benefits and side effects.
• To identify existing or prevalent guidelines on
  oral prescription.

3
Methods

• List of all children registered as ICD-10
  (G80-83) codes as having cerebral palsy under the
  Warrington CDC. Obtained from IT (medical
  records) at Warrington CSU.
• Notes retrieved and children currently or
  previously on Baclofen identified.
• Data collated on above sub-set.

4

• Total children registered with CP 78
• Total notes obtained 43
• Children with CP on analysis 42
• Children currently on Baclofen 09
• Children previously on Baclofen 02

5

• n total no 11
• of children with CP on
• Baclofen is 11/42 26.2
• Avg age of our sub group 10y 1m
• Avg age at diagnoses 30 m
• Males 8
• Females 3

6
Body pattern involvement

• Diplegia 3
• Quad/tetraplegia 3
• Hemiparesis/plegia 1
• Undiagnosed syndrome 2
• CP -unspecified 2

7
Etiology

• Asphyxia 8
• Syndrome (Undiagnosed) 2
• Unspecified 1

8
Movt problems

• Spasticity 10
• Dystonia 1

9
Co-morbidities
10
Therapies

• Physiotherapy
• Occupational therapy
• Speech language

11
Other medications
12
Baclofen data

• Freq
• ODS 1
• BDS 3
• TDS 6
• QDS 1

13
BNF

• BNF advises 0.75 mg 2 mg/kg daily or 2.5 mg
  q.d.s increased gradually to maintainence.
• Child 12 years 1020 mg daily in divided doses,
  Child 26 years 2030 mg daily in divided doses,
  Child 610 years 3060 mg daily in divided doses
• Child 1018 years 5 mg 3 times daily increased
  gradually max. 2.5 mg/kg or 100 mg daily

14
PT AGE MOVT Baclofen DOSE Mg/kg/d months when started By grade Dose At Starting mg GMFCS NOW
TB 13 y 5 m spasticity yes 20 od ? 55 SG 2.5 od 1
JC 6 y 9 m spasticity yes 5,5,5 0.88 19 C 1 mg tds 4
RF 8 y 10 m spasticity yes 10,10,15 1.4 ? ? 4
GC 10 y 7 m spasticity yes 5,5,5 0.86 18 C 2.5 mg bd 3
SDC 10 y 2 m spasticity yes 10,10,10 1 19 C 2.5 mg bd 2
KK 12 y 2 m spasticity trialled nil nil 79 C 2.5 mg tds upto 5 bd 4
DM 6 y dystonia yes 4,4,4,4 0.8 18 C 2.5 mg tds 5
MW 9 y 7 m spasticity trialled nil nil 45 C 2.5 mg tds upto 5 bds 5
EW 6 y 10 m spasticity yes 5,5,5 1.5 14 ? 3 mg tds 5
VR 14 y 10 m spasticity yes 5,5 0.25 107 C 2.5 bd upto 5 tds 4
LT 5 y 9 m spasticity yes 20,15,15 1.85 58 C 2.5 bd upto 5 tds 3
15
BNF

• BNF advises 0.75 mg 2 mg/kg daily or 2.5 mg
  q.d.s increased gradually to maintainence.
• Child 12 years 1020 mg daily in divided doses,
  Child 26 years 2030 mg daily in divided doses,
  Child 610 years 3060 mg daily in divided doses
• Child 1018 years 5 mg 3 times daily increased
  gradually max. 2.5 mg/kg or 100 mg daily

16
Side effects

• Nil 7
• KK- stopped as no response(no s.e.)
• MW - stopped as worsening reflux
• DM vomiting,
• JC -- decreased appetite
• VR-Increasing spasticity, stopped walking
  unaided, swallowing diff---dose reduced

17
Conclusions

• All patients prescribed for increasing
  hypertonia.
• No standardised regime of prescription
  identified-i.e. starting regime, increasing
  dosage, frequency.
• All mg/kg dosages were within BNF limits.
• Some side-effects noted, mainly increasing
  feeding problems and reflux. ?statistical
  significance due to small numbers.
• No guidelines identified in literature search
  specifically for oral Baclofen prescription.

18
RECOMMENDATIONS

• To propose a regional standardised regime for
  prescription.
• To generate information/advice sheet on Baclofen
  for prescribers in the hospitals and community.
• To generate clinic sheet for prescribers to
  document information on Baclofen on the first and
  then on each clinic visit.

19

• THANK YOU