Intrathecal Baclofen in Children with Cerebral Palsy: A Critical Review of Selection Criteria, Rehabilitation Goals, Outcomes, and Complications.

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.