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 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

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. 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