Cerebral palsy medical therapy: Difference between revisions

	Cerebral palsy Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Cerebral Palsy from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Cerebral palsy medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Cerebral palsy medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Cerebral palsy medical therapy
CDC on Cerebral palsy medical therapy
Cerebral palsy medical therapy in the news
Blogs on Cerebral palsy medical therapy
Directions to Hospitals Treating Psoriasis
Risk calculators and risk factors for Cerebral palsy medical therapy

← Older edit Newer edit →

VisualWikitext

Revision as of 01:10, 6 October 2017

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

Overview

Pharmacologic medical therapies for cerebral palsy include botulinum toxin, intrathecal baclofen, and oral antispastics. The management of cerebral palsy should be individualized according to the patient's need and status of disease. The disease itself is not progressive but the presentations might change with the maturation of the brain and the development of the skeletal system. Medical therapy aims at improvement of the motor function through relieving the spasticity of the limbs and preventing the occurrence of convulsions.

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 4: / Line 4: @@
 ==Overview==
-There is no treatment for [disease name]; the mainstay of therapy is supportive care.
+Pharmacologic medical therapies for cerebral palsy include botulinum toxin, intrathecal baclofen, and oral antispastics. The management of cerebral palsy should be individualized according to the patient's need and status of disease. The disease itself is not progressive but the presentations might change with the maturation of the brain and the development of the skeletal system. Medical therapy aims at improvement of the motor function through relieving the spasticity of the limbs and preventing the occurrence of convulsions.
-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==