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Does baclofen for the management of spasticity increase the risk of seizures?
  1. Husain Malalla1,
  2. Kathleen M Gorman1,2
  1. 1 Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Dublin, Ireland
  2. 2 School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
  1. Correspondence to Dr Kathleen M Gorman, Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Dublin, Ireland; kathleen.gorman1{at}ucd.ie

https://doi.org/10.1136/archdischild-2023-325977

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    Scenario

    A 6-year-old boy with cerebral palsy (CP) (Gross Motor Function Classification System III) is attending the complex tone clinic. He was born at 28 weeks after a stormy neonatal course. He was subsequently diagnosed with periventricular leucomalacia and focal epilepsy. He is prescribed levetiracetam and has remained seizure free now for 6 months. He has increased tone (spasticity) in his lower limbs, which is impacting on activities of daily living, such as dressing. You wish to start baclofen for tone management. However, his mother is anxious as she read on a parent website that baclofen can cause seizures.

    Structured clinical question

    In children with epilepsy (patient), does baclofen (intervention) increase seizure frequency? (outcome)

    Search

    Primary sources

    MEDLINE and OVID were searched via PubMed, from 1976 to April 2023. Advanced search mode was used using the following search terms:

    • “Baclofen” AND “seizure” OR “epilepsy”.

    Only studies in English were reviewed.

    Output

    A total of 145 abstracts with keywords as described in the search criteria were reviewed. Three studies were identified as relevant to the clinical question. The reasons for exclusion (adult studies, seizures in baclofen overdose or withdrawal) are summarised in online supplemental table 1. The critical appraisal of papers is summarised in table …

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    Footnotes

    • Contributors HM contributed to the acquisition, analysis and interpretation of the data. He completed the first draft of the manuscript and approved the final manuscript. KMG contributed to the concept/design of the manuscript, reviewed and revised subsequent drafts and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.