Treatment of central neuropathic pain (CNP) in children with brain damage

Aim of the study: Assessing the effectiveness of introducing gabapentin in children suffering from permanent and severe brain damage and CNP. Patients and methods: To a cohort od 32 patients (14 females), we introduced gabapentin and in another of 27 patients, baclofen as well. The average age was 14.5 yrs (from 3 – 27). Fifteen children (46.8%) were born prematurely, two (6.2%) were twins, 14 (43.7%) had pre- and/or peripartal asphyxia of various degrees. Other patients had metabolic diseases, congenital brain malformations (holoprosencephaly, agenesis of the corpus callosum), polytrauma and subsequent coma vigil. Apart from cerebral paralysis of the spastic type, all patients had epilepsy and symptoms of CNP with clinical manifestations – chronic painful stimuli, sleep deprivation, loss of body mass and great difficulty in provision of rehabilitation and physical therapy. Taking into account the fact that these are severely handicapped children, in our work we could not use any of the usual painscales, but we relied on clinical observations: 1.) crying, 2.) quality of sleep, 3.) development of motor skills, 4.) gain in body mass. In 27 (84%) of patients, with the introduction of gabapentin alone or in combination with baclofen, improvement was registered in the assessment of all the above mentioned parameters. Conclusion: By introduction of gabapentin in the treatment and habilitation of children with severe brain damage, regardless of its etiology, accompanied with CNP, significant improvement in quality of life can be achieved in such patients.

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