Transcript Audit on the use of oral Baclofen in children with cerebral palsy

AUDIT ON THE USE OF ORAL
BACLOFEN IN CHILDREN WITH
CEREBRAL PALSY ATTENDING
WARRINGTON CDC
Dr B George
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.

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.

Total children registered with CP
 Total notes obtained
 Children with CP on analysis
 Children currently on Baclofen
 Children previously on Baclofen

78
43
42
09
02

‘n’ total no
11
% of children with CP on
Baclofen is 11/42 =
26.2%
Avg age of our sub group
 Avg age at diagnoses
 Males
 Females
10y 1m
30 m
8
3


BODY PATTERN INVOLVEMENT
Diplegia
 Quad/tetraplegia
 Hemiparesis/plegia
 Undiagnosed syndrome
 CP -unspecified

3
3
1
2
2
ETIOLOGY
Asphyxia
 Syndrome (Undiagnosed)
 Unspecified

8
2
1
MOVT PROBLEMS

Spasticity
10

Dystonia
1
CO-MORBIDITIES
THERAPIES
Physiotherapy
 Occupational therapy
 Speech & language

OTHER MEDICATIONS
BACLOFEN – DATA
Freq
 ODS
 BDS
 TDS
 QDS
1
3
6
1
BNF
BNF advises 0.75 mg – 2 mg/kg daily or 2.5 mg
q.d.s increased gradually to maintainence.
 Child 1–2 years 10–20 mg daily in divided doses,
Child 2–6 years 20–30 mg daily in divided doses,
Child 6–10 years 30–60 mg daily in divided doses
 Child 10–18 years 5 mg 3 times daily increased
gradually; max. 2.5 mg/kg or 100 mg daily

MOVT
Baclofen
Mg/kg/d
months
when
started
By grade
spasticity
yes
20 od
?
55
SG
2.5 od
1
6y9m
spasticity
yes
5,5,5
0.88
19
C
1 mg tds
4
8 y 10 m
spasticity
yes
10,10,15
1.4
?
?
10 y 7 m
spasticity
yes
5,5,5
0.86
18
C
2.5 mg bd
3
10 y 2 m
spasticity
yes
10,10,10
1
19
C
2.5 mg bd
2
12 y 2 m
spasticity
trialled
nil
nil
79
C
2.5 mg tds
upto 5 bd
4
6y
dystonia
yes
4,4,4,4
0.8
18
C
2.5 mg tds
5
9y7m
spasticity
trialled
nil
nil
45
C
2.5 mg tds
upto 5 bds
5
6 y 10 m
spasticity
yes
5,5,5
1.5
14
?
3 mg tds
5
14 y 10 m
spasticity
yes
5,5
0.25
107
C
2.5 bd
upto 5 tds
4
5y9m
spasticity
yes
20,15,15
1.85
58
C
2.5 bd
upto 5 tds
3
AGE
DOSE
PT
TB
JC
13 y 5 m
Dose At
Starting
mg
GMFCS
NOW
4
RF
GC
SDC
KK
DM
MW
EW
VR
LT
BNF
BNF advises 0.75 mg – 2 mg/kg daily or 2.5 mg
q.d.s increased gradually to maintainence.
 Child 1–2 years 10–20 mg daily in divided doses,
Child 2–6 years 20–30 mg daily in divided doses,
Child 6–10 years 30–60 mg daily in divided doses
 Child 10–18 years 5 mg 3 times daily increased
gradually; max. 2.5 mg/kg or 100 mg daily

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

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.

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.


THANK YOU