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AUDIT ON THE USE OF ORAL BACLOFEN IN CHILDREN WITH CEREBRAL PALSY ATTENDING WARRINGTON CDC Dr B George.

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Presentation on theme: "AUDIT ON THE USE OF ORAL BACLOFEN IN CHILDREN WITH CEREBRAL PALSY ATTENDING WARRINGTON CDC Dr B George."— Presentation transcript:

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

2 A IM 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 M ETHODS 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 CP78 Total notes obtained 43 Children with CP on analysis42 Children currently on Baclofen09 Children previously on Baclofen02

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 Males8 Females3

6 B ODY PATTERN INVOLVEMENT Diplegia3 Quad/tetraplegia3 Hemiparesis/plegia1 Undiagnosed syndrome2 CP -unspecified2

7 E TIOLOGY Asphyxia8 Syndrome (Undiagnosed)2 Unspecified 1

8 M OVT PROBLEMS Spasticity 10 Dystonia1

9 C O - MORBIDITIES

10 T HERAPIES Physiotherapy Occupational therapy Speech & language

11 O THER MEDICATIONS

12 B ACLOFEN – DATA Freq ODS1 BDS3 TDS6 QDS1

13 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

14 PT AGEMOVTBaclofenDOSEMg/kg/dmonths when started By gradeDose At Starting mg GMFCS NOW TB 13 y 5 m spasticityyes20 od?55SG2.5 od 1 JC 6 y 9 m spasticityyes5,5,50.8819C1 mg tds 4 RF 8 y 10 m spasticityyes10,10,151.4?? 4 GC 10 y 7 m spasticityyes5,5,50.8618C2.5 mg bd 3 SDC 10 y 2 m spasticityyes10,10,10119C2.5 mg bd 2 KK 12 y 2 m spasticitytriallednil 79C2.5 mg tds upto 5 bd 4 DM 6 y dystoniayes4,4,4,40.818C2.5 mg tds 5 MW 9 y 7 m spasticitytriallednil 45C2.5 mg tds upto 5 bds 5 EW 6 y 10 m spasticityyes5,5,51.514?3 mg tds 5 VR 14 y 10 m spasticityyes5,50.25107C2.5 bd upto 5 tds 4 LT 5 y 9 m spasticityyes20,15,151.8558C2.5 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 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

16 S IDE EFFECTS Nil7 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 C ONCLUSIONS 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


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