Cerebral palsy medical therapy

Cerebral palsy Microchapters
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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.

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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.