{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T16:04:41Z","timestamp":1779725081886,"version":"3.53.1"},"reference-count":59,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Spasticity is a major contributor to pain, impaired mobility, contractures, and caregiver burden in children with cerebral palsy. Intrathecal baclofen (ITB) is an established treatment for severe generalized spasticity when rehabilitation, oral medications, and focal interventions are insufficient or poorly tolerated. Methods: This critical review synthesizes current evidence on ITB in children with cerebral palsy, focusing on patient selection, screening, rehabilitation goals, functional outcomes, complications, and long-term management. Results: Available evidence consistently demonstrates substantial and sustained tone reduction with ITB, with associated improvements in comfort, positioning, ease of care, pain, and selected quality-of-life domains. However, gains in gross motor function are variable and depend on baseline motor phenotype, individualized treatment goals, and careful dose titration. Device-related complications, infections, catheter dysfunction, overdose, and withdrawal remain clinically significant risks requiring specialized multidisciplinary follow-up. Compared with selective dorsal rhizotomy and botulinum toxin injections, ITB provides a reversible and programmable option particularly suited to children with severe, generalized spasticity and high caregiving needs. Conclusions: ITB represents an important component of comprehensive, goal-directed spasticity management in appropriately selected children. Further high-quality longitudinal and comparative studies are needed to define long-term functional and cost-effectiveness outcomes better.<\/jats:p>","DOI":"10.3390\/jcm15114091","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T15:05:08Z","timestamp":1779721508000},"page":"4091","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intrathecal Baclofen in Children with Cerebral Palsy: A Critical Review of Selection Criteria, Rehabilitation Goals, Outcomes, and Complications"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1951-4837","authenticated-orcid":false,"given":"Natalia","family":"Retkowska-Tomaszewska","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Pediatric Surgery, Traumatology and Urology, Karol Jonscher Clinical Hospital, 60-572 Poznan, Poland"},{"name":"Department of Pediatric Surgery, Traumatology and Urology, Institute of Pediatrics, Poznan University of Medical Sciences, 60-572 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0019-1137","authenticated-orcid":false,"given":"Piotr","family":"Defort","sequence":"additional","affiliation":[{"name":"Department of Nervous System Diseases, Collegium Medicum, University of Zielona G\u00f3ra, 65-046 Zielona G\u00f3ra, Poland"},{"name":"Neurosurgery Center, Karol Marcinkowski University Hospital, 65-046 Zielona G\u00f3ra, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7179-1474","authenticated-orcid":false,"given":"Anna-Maria","family":"Barciszewska","sequence":"additional","affiliation":[{"name":"Intraoperative Imaging Unit, Department of Neurosurgery, Institute of Nervous System Diseases, Poznan University of Medical Sciences, 60-355 Poznan, Poland"},{"name":"Department of Neurosurgery, University Clinical Hospital, 60-355 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4583-5517","authenticated-orcid":false,"given":"Dariusz","family":"Patkowski","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/S0140-6736(25)00686-5","article-title":"Cerebral palsy","volume":"406","author":"Novak","year":"2025","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S125","DOI":"10.21037\/tp.2020.01.01","article-title":"Cerebral palsy in children: A clinical overview","volume":"9","author":"Patel","year":"2020","journal-title":"Transl. Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2622310","DOI":"10.1155\/2022\/2622310","article-title":"A Review on Recent Advances of Cerebral Palsy","volume":"2022","author":"Paul","year":"2022","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1038\/s41591-024-02912-z","article-title":"Exome sequencing reveals genetic heterogeneity and clinically actionable findings in children with cerebral palsy","volume":"30","author":"Wang","year":"2024","journal-title":"Nat. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"193","DOI":"10.2340\/16501977-2211","article-title":"Efficacy and safety of oral baclofen in the management of spasticity: A rationale for intrathecal baclofen","volume":"49","author":"Ertzgaard","year":"2017","journal-title":"J. Rehabil. Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Kaya Keles, C.S., and Ates, F. (2022). Botulinum Toxin Intervention in Cerebral Palsy-Induced Spasticity Management: Projected and Contradictory Effects on Skeletal Muscles. Toxins, 14.","DOI":"10.3390\/toxins14110772"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1111\/ner.12388","article-title":"Best practices for intrathecal baclofen therapy: Dosing and long-term management","volume":"19","author":"Boster","year":"2016","journal-title":"Neuromodulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1080\/02688690802233364","article-title":"Intrathecal baclofen therapy for neurological disorders: A sound knowledge base but many challenges remain","volume":"22","author":"Brennan","year":"2008","journal-title":"Br. J. Neurosurg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S0140-6736(85)90228-4","article-title":"Continuous intrathecal baclofen for severe spasticity","volume":"2","author":"Penn","year":"1985","journal-title":"Lancet"},{"key":"ref_10","first-page":"CD004552","article-title":"Intrathecal baclofen for treating spasticity in children with cerebral palsy","volume":"11","author":"Hasnat","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/j.nrl.2022.04.008","article-title":"Intrathecal baclofen therapy as treatment for spasticity and dystonia: Review of cases in a pediatric palliative care unit","volume":"39","author":"Puertas","year":"2024","journal-title":"Neurologia"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1111\/j.1469-8749.2008.03089.x","article-title":"Content validity of the expanded and revised Gross Motor Function Classification System","volume":"50","author":"Palisano","year":"2008","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1080\/09638280500158422","article-title":"The epidemiology of cerebral palsy","volume":"28","author":"Odding","year":"2006","journal-title":"Disabil. Rehabil."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Westbom, L., Hagglund, G., and Nordmark, E. (2007). Cerebral palsy in a total population of 4\u201311 year olds in southern Sweden. Prevalence and distribution according to different CP classification systems. BMC Pediatr., 7.","DOI":"10.1186\/1471-2431-7-41"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1191\/026921599677595404","article-title":"A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity","volume":"13","author":"Pandyan","year":"1999","journal-title":"Clin. Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1191\/0269215506cr922oa","article-title":"The Tardieu Scale differentiates contracture from spasticity whereas the Ashworth Scale is confounded by it","volume":"20","author":"Patrick","year":"2006","journal-title":"Clin. Rehabil."},{"key":"ref_17","first-page":"8","article-title":"A report: The definition and classification of cerebral palsy April 2006","volume":"109","author":"Rosenbaum","year":"2007","journal-title":"Dev. Med. Child Neurol. Suppl."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1001\/jama.1991.03460110084029","article-title":"Intrathecal baclofen for spasticity in cerebral palsy","volume":"265","author":"Albright","year":"1991","journal-title":"JAMA"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Sindou, M., Duraffourg, M., and Georgoulis, G. (2022). Neurosurgery for Spasticity: A Practical Guide for Treating Children and Adults, Springer Nature. [2nd ed.].","DOI":"10.1007\/978-3-030-92717-2"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1152\/physiol.00054.2018","article-title":"A critical evaluation of current concepts in cerebral palsy","volume":"34","author":"Brandenburg","year":"2019","journal-title":"Physiology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"354906","DOI":"10.1155\/2014\/354906","article-title":"Pathophysiology of spasticity: Implications for neurorehabilitation","volume":"2014","author":"Trompetto","year":"2014","journal-title":"BioMed Res. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"11","DOI":"10.5535\/arm.22108","article-title":"Effect of Intrathecal Baclofen Pump on Scoliosis in Children with Cerebral Palsy: A Meta-Analysis","volume":"47","author":"Lee","year":"2023","journal-title":"Ann. Rehabil. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1111\/dmcn.15509","article-title":"Does intrathecal baclofen therapy decrease the progression of hip displacement in young patients with cerebral palsy?","volume":"65","author":"Asma","year":"2023","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_24","first-page":"540","article-title":"Preliminary trial of carisoprodol in multiple sclerosis","volume":"192","author":"Ashworth","year":"1964","journal-title":"Practitioner"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1093\/ptj\/67.2.206","article-title":"Interrater reliability of a modified Ashworth scale of muscle spasticity","volume":"67","author":"Bohannon","year":"1987","journal-title":"Phys. Ther."},{"key":"ref_26","first-page":"S23","article-title":"Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with cerebral palsy","volume":"6","author":"Boyd","year":"1999","journal-title":"Eur. J. Neurol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1080\/09638280500404305","article-title":"A systematic review of the Tardieu Scale for the measurement of spasticity","volume":"28","author":"Haugh","year":"2006","journal-title":"Disabil. Rehabil."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1080\/13638490500235581","article-title":"A comparison of goal attainment scaling and the Canadian Occupational Performance Measure for paediatric rehabilitation research","volume":"9","author":"Cusick","year":"2006","journal-title":"Pediatr. Rehabil."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1111\/j.1469-8749.2006.tb01227.x","article-title":"Initial development and validation of the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD)","volume":"48","author":"Narayanan","year":"2006","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1111\/j.1469-8749.1997.tb07414.x","article-title":"Development and reliability of a system to classify gross motor function in children with cerebral palsy","volume":"39","author":"Palisano","year":"1997","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1017\/S0012162207000126.x","article-title":"Psychometric properties of the quality of life questionnaire for children with CP","volume":"49","author":"Waters","year":"2007","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1111\/j.1469-8749.2007.00550.x","article-title":"Goal attainment scaling in paediatric rehabilitation: A critical review of the literature","volume":"49","author":"Steenbeek","year":"2007","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_33","unstructured":"Ghanavatian, S., and Derian, A. (2024). Baclofen Toxicity. StatPearls, StatPearls Publishing."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"20503121211022197","DOI":"10.1177\/20503121211022197","article-title":"Baclofen therapeutics, toxicity, and withdrawal: A narrative review","volume":"9","author":"Romito","year":"2021","journal-title":"SAGE Open Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1136\/practneurol-2021-003184","article-title":"Intrathecal baclofen pumps: What the neurologist needs to know","volume":"22","author":"Balaratnam","year":"2022","journal-title":"Pract. Neurol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1111\/bcp.12781","article-title":"A pharmacokinetic-pharmacodynamic model for intrathecal baclofen in patients with severe spasticity","volume":"81","author":"Heetla","year":"2016","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"487","DOI":"10.3171\/2009.6.PEDS0921","article-title":"Infections related to intrathecal baclofen therapy in children and adults: Frequency and risk factors","volume":"4","author":"Fjelstad","year":"2009","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1007\/s00381-007-0298-5","article-title":"Interaction of ventriculoperitoneal shunt and baclofen pump","volume":"23","author":"Fulkerson","year":"2007","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1111\/j.1469-8749.2009.03515.x","article-title":"Intrathecal baclofen","volume":"52","author":"Russman","year":"2010","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ejpn.2025.04.002","article-title":"From childhood to adulthood: Long-term assessment of continuous intrathecal baclofen therapy in non-ambulant spastic cerebral palsy","volume":"56","author":"Martens","year":"2025","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e7472","DOI":"10.1097\/MD.0000000000007472","article-title":"Outcomes of intrathecal baclofen therapy in patients with cerebral palsy and acquired brain injury","volume":"96","author":"Yoon","year":"2017","journal-title":"Medicine"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3209","DOI":"10.1007\/s10143-021-01550-0","article-title":"Intrathecal baclofen, selective dorsal rhizotomy, and extracorporeal shockwave therapy for the treatment of spasticity in cerebral palsy: A systematic review","volume":"44","author":"Kudva","year":"2021","journal-title":"Neurosurg. Rev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"298","DOI":"10.3171\/2024.10.PEDS24228","article-title":"Intraventricular baclofen for the treatment of pediatric spasticity in cerebral palsy: Technique and outcomes","volume":"35","author":"Piazza","year":"2025","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"315","DOI":"10.3171\/2012.6.PEDS11456","article-title":"Intraventricular baclofen as an alternative to intrathecal baclofen for intractable spasticity or dystonia: Outcomes and technical considerations","volume":"10","author":"Turner","year":"2012","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_45","first-page":"215","article-title":"Subfascial implantation of intrathecal baclofen pumps in children: Technical note","volume":"94","author":"Albright","year":"2001","journal-title":"J. Neurosurg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/ases.12752","article-title":"Laparoscopic fundoplication for a child with abdominal intrathecal Baclofen pump","volume":"13","author":"Okata","year":"2020","journal-title":"Asian J. Endosc. Surg."},{"key":"ref_47","first-page":"1863","article-title":"Unusual placement of intrathecal baclofen pumps: Report of two cases","volume":"31","author":"Devine","year":"2015","journal-title":"Childs Nerv. Syst."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1111\/ner.12467","article-title":"Best practices for intrathecal baclofen therapy: Troubleshooting","volume":"19","author":"Saulino","year":"2016","journal-title":"Neuromodulation"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"CASE24290","DOI":"10.3171\/CASE24290","article-title":"Peritoneal baclofen pump migration: A rare complication of subfascial placement. Illustrative cases","volume":"8","author":"Ricciardelli","year":"2024","journal-title":"J. Neurosurg. Case Lessons"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"69","DOI":"10.3171\/2023.3.PEDS22508","article-title":"Use of intraoperative topical antibiotics to reduce intrathecal baclofen pump surgical site infections: A single institution\u2019s experience over 24 years","volume":"32","author":"Cobourn","year":"2023","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1111\/j.1469-8749.2009.03473.x","article-title":"Survival of individuals with cerebral palsy receiving continuous intrathecal baclofen treatment: A matched-cohort study","volume":"52","author":"Krach","year":"2010","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2609","DOI":"10.1007\/s10072-023-06757-1","article-title":"CNS adverse effects of intrathecal baclofen treatment for spasticity in children with cerebral palsy and epilepsy: A case report","volume":"44","author":"Gallo","year":"2023","journal-title":"Neurol. Sci."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"96","DOI":"10.17116\/neiro20248803196","article-title":"Intrathecal baclofen therapy: A 30-year experience","volume":"88","author":"Morozov","year":"2024","journal-title":"Zh. Vopr. Neirokhir. Im. N. N. Burdenko"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Masrour, M., Zare, A., Presedo, A., and Nabian, M.H. (2024). Intrathecal baclofen efficacy for managing motor function and spasticity severity in patients with cerebral palsy: A systematic review and meta-analysis. BMC Neurol., 24.","DOI":"10.1186\/s12883-024-03647-7"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"106","DOI":"10.17116\/neiro202387031106","article-title":"Methods and results of neurosurgical treatment of cerebral palsy","volume":"87","author":"Dekopov","year":"2023","journal-title":"Zh. Vopr. Neirokhir. Im. N. N. Burdenko"},{"key":"ref_56","first-page":"100049","article-title":"Musculoskeletal Pain Outcomes Pre- and Post Intrathecal Baclofen Pump Implant in Children With Cerebral Palsy: A Prospective Cohort Study","volume":"2","author":"Barney","year":"2020","journal-title":"Arch. Rehabil. Res. Clin. Transl."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1053\/apmr.2003.50030","article-title":"Oral motor, communication, and nutritional status of children during intrathecal baclofen therapy: A descriptive pilot study","volume":"84","author":"Bjornson","year":"2003","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1111\/dmcn.13625","article-title":"Intrathecal baclofen in dyskinetic cerebral palsy: Effects on function and activity","volume":"60","author":"Eek","year":"2018","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_59","first-page":"9","article-title":"Selective dorsal rhizotomy in cerebral palsy: Selection criteria and postoperative physical therapy protocols","volume":"36","author":"Tedesco","year":"2018","journal-title":"Rev. Paul. Pediatr."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4091\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T15:21:57Z","timestamp":1779722517000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4091"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":59,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15114091"],"URL":"https:\/\/doi.org\/10.3390\/jcm15114091","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]}}}