EFFECTIVENESS AND SAFETY OF CERVICAL CATHETER TIP PLACEMENT IN INTRATHECAL BACLOFEN TREATMENT OF SPASTICITY: A SYSTEMATIC REVIEW

Objective: To evaluate the effectiveness and safety of intrathecal baclofen treatment of spasticity, ad ministered via a cervical catheter tip. Design: A review of PubMed and the Cochrane Library up to September 2020. No restriction in study design. Two reviewers independently evaluated eli- gibility, extracted data and evaluated risk of bias. Studies were included in which patients were treat- ed with intrathecal baclofen for spasticity, with the catheter tip at or above the first thoracic level, inde- pendent of diagnosis and age. Results: Thirteen studies were eligible, with a mod- erate to critical risk of bias. Improvement in spastic- ity was seen only in the upper extremity in 6% of subjects, only in the lower extremity in 2%, in both upper and lower extremities in 50% and without specification of location in 41%. Upper extremity function improved in 88% of cases. Neither drug- related (1%) nor technical (21%) complications oc- curred more often than in lower placement of the tip. Effects on respiratory function and sleep apnoea were not investigated. Conclusion: Cervically administered intrathecal ba- clofen seems to improve upper extremity spasticity and function, without causing more complications than thoracolumbar intrathecal baclofen. However, the mainly drug-related complications have not been thoroughly investigated and the available literature is of poor methodological quality. Further research is needed to confirm the efficacy and safety of this procedure.