Cerebral palsy medical therapy: Difference between revisions

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VisualWikitext

Revision as of 19:00, 5 October 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

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.

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.

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.

References

Template:WH Template:WS

@@ Line 47: / Line 47: @@
 ==Medical Therapy==
-*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
+===Botulinum toxin===
-*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
+*Botulinum toxin acts on the neuromuscular junction preventing the release of acetylcholine.
-*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
+*It has a relaxant effect on the muscles undergoing contractures.
-*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
+*Primarily used if there are contractures causing deformity or jeopardizing the nearby joints.
-===Disease Name===
+*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.
-* '''1 Stage 1 - Name of stage'''
+===Intrathecal baclofen===
-** 1.1 '''Specific Organ system involved 1'''
-*** 1.1.1 '''Adult'''
-**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)'''
-**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
-**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
-**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
-**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
-**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
-*** 1.1.2 '''Pediatric'''
-**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
-***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
-***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
-***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
-***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
-***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
-****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
-***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
-***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
-***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
-***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
-** 1.2 '''Specific Organ system involved 2'''
-*** 1.2.1 '''Adult'''
-**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
-*** 1.2.2  '''Pediatric'''
-**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
-* 2 '''Stage 2 - Name of stage'''
+*Baclofen is administered through a pump into the subarachnoid space.
-** 2.1 '''Specific Organ system involved 1 '''
+*It can achieve higher CSF levels of the drug with less side effects.
-**: '''Note (1):'''
+*It acts by blocking the I-a sensory afferents.
-**: '''Note (2)''':
+*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.
-**: '''Note (3):'''
+*It carries more risk of complications than other non interventional lines of treatment.
-*** 2.1.1 '''Adult'''
+*The pump must refilled every month together with assessment for the occurrence of complications.
-**** Parenteral regimen
+*Complications such as hypotonia and confusion occur in about half of the patients.
-***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
+*The dose is adjusted by the physician according to the response and the development of side effects.
-***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
-***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
+===Oral muscle relaxants===
-**** Oral regimen
-***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
+====Benzodiazepines====
-***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
+*Binds to GABA receptors and causes presynaptic inhibition of the neurotransmission.
-***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
+*Most useful for acute cases of severe spasticity.
-***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
+*Due to its muscle relaxing effect, it can aggravate the swallowing difficulties and cause aspiration.
-***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
-***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
+====Baclofen====
-*** 2.1.2 '''Pediatric'''
+*GABA analogue and causes presynaptic inhibition of neurotransmission.
-**** Parenteral regimen
+*Much less effective than intrathecal baclofen.
-***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
-***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
+====Dantrolene====
-***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
+*Direct muscle relaxant by inhibiting the release of Ca+2  from the sarcoplasmic reticulum.
-**** Oral regimen
+*Used only in the short term for treatment of acute cases of severe hypertonicity.
-***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
-***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
-***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
-***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
-***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
-***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
-** 2.2 '''Other Organ system involved 2'''
-**: '''Note (1):'''
-**: '''Note (2):'''
-**: '''Note (3):'''
-*** 2.2.1 '''Adult'''
-**** Parenteral regimen
-***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
-***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
-***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
-**** Oral regimen
-***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
-***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
-***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
-***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
-***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
-***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
-*** 2.2.2 '''Pediatric'''
-**** Parenteral regimen
-***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
-***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
-***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
-**** Oral regimen
-***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
-***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
-***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
-***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
-***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
-***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
 ==References==