Cerebral palsy medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Medical Therapy
Botulinum toxin
- Botulinum toxin acts on the neuromuscular junction preventing the release of acetylcholine.
- It has a relaxant effect on the muscles undergoing contractures.
- Primarily used if there are contractures causing deformity or jeopardizing the nearby joints.
- The injections cause temporary improvement in the function of the affected limbs.
- Botulinum toxin injections may decrease the joint and bone deformities resulting from the contractures especially if combined with casting.
- Children under four years in the early stages of contractures are the most category of patients to benefit from botulinum toxin.
- Botulinum toxin delays the need for a surgery and decreases the magnitude of intervention.
- The effect is temporary and the injection has to be repeated every three to six months.
- Generalized weakness due to the global effect of the drug was reported.
- The dose of abobotulinum toxin A is 20-30 unit/kg divided between the injected limbs. The dose should not exceed 1000 units.
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Intrathecal baclofen
- Baclofen is administered through a pump into the subarachnoid space.
- It can achieve higher CSF levels of the drug with less side effects.
- It acts by blocking the I-a sensory afferents.
- It is indicated in the patients with the highest of spasticity that is causing dysfuction and pain not responding to the more conventional methods of treatment.
- It carries more risk of complications than other non interventional lines of treatment.
- The pump must refilled every month together with assessment for the occurrence of complications.
- Complications such as hypotonia and confusion occur in about half of the patients.
- The dose is adjusted by the physician according to the response and the development of side effects.
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Oral muscle relaxants
Benzodiazepines
- Binds to GABA receptors and causes presynaptic inhibition of the neurotransmission.
- Most useful for acute cases of severe spasticity.
- Due to its muscle relaxing effect, it can aggravate the swallowing difficulties and cause aspiration.
Baclofen
- GABA analogue and causes presynaptic inhibition of neurotransmission.
- Much less effective than intrathecal baclofen.
Dantrolene
- Direct muscle relaxant by inhibiting the release of Ca+2 from the sarcoplasmic reticulum.
- Used only in the short term for treatment of acute cases of severe hypertonicity.