The contribution of tone to resting energy expenditure in children with moderate to severe cerebral palsy: Evaluation utilizing intrathecal baclofen injection.

The extent to which high muscle tone contributes to the caloric needs of children with cerebral palsy (CP) is debated. Understanding its contribution is important in predicting calorie needs in this population which frequently experiences under nutrition. Intrathecal baclofen is an innovative therapy now used for treatment of excessive tone. We prospectively studied the changes in resting energy expenditure (REE) observed in 12 children with CP undergoing intrathecal baclofen injection. REE was measured in the fasting state before intrathecal injection of 50 micrograms of baclofen. Patients remained fasting and REE measures were repeated four hours later. Tone changes were assessed using the Modified Ashworth Scale at the same time points. One child was excluded from study because he became increasingly agitated over the observation period and one child demonstrated no tone reduction after the baclofen injection. In the remaining 10 patients, the average REE prior to injection was 101 ± 17% of predicted and decreased to 84 ± 24% of predicted after injection (p<0.004). This study suggests that tone contributes substantially to the caloric needs of children with CP and must be carefully considered when providing nutritional recommendations.