Pharmacological Management of Spasticity in Children With Cerebral Palsy

Abstract

To obtain continuing education credit: 1. Read the article carefully. 2. Read each question and determine the correct answer. 3. Visit PedsCE SM , ce.napnap.org, to complete the online Posttest and evaluation. 4. You must receive 70% correct responses to receive the certificate. 5. Tests will be accepted until October 31, 2021. OBJECTIVES 1. Recognize available medications used to manage cerebral palsy−associated spasticity. 2. Evaluate the pharmacology of and current efficacy and safety data on oral and parenteral medications used to manage spasticity in children with cerebral palsy. 3. Describe practical and patient-specific considerations when choosing between medications used to manage spasticity in children with cerebral palsy. Posttest Questions Contact hours: 1.5 (0.25 Controlled Substance) Passing score: 70% This continuing education activity is administered by the National Association of Pediatric Nurse Practitioners (NAPNAP) as an Agency providing continuing education credit. Individuals who complete this program and earn a 70% or higher score on the Posttest will be awarded 1.5 contact hours, of which 1.5 are Pharmacology CE contact hours and 0.25 are related to Controlled Substance.

The Correlation between Gross Motor Function Classification System and Spasticity in Children with Cerebral Palsy

“…Treatment using chemical drugs and surgery should be evidence-based and depend on the degree of functional impairment resulting from the spasticity and its location. The therapies that are often used are botulinum toxin, intrathecal baclofen, surgical interventions such as selective rhizotomy and orthopedic surgery (Reilly et al, 2020).…”

“…Increased tone is useful for children which will help keep the legs straight, thereby supporting the child's weight against gravity so that by increasing the tone of the extensors of the torso will help the child to be able to stand and step. Spasticity will also help maintain muscle mass and bone density (Reilly et al, 2020).…”

Inhibitory Synaptic Influences on Developmental Motor Disorders

“…Indeed, in sCP, a multitude of treatments aimed at improving inhibitory neurotransmission or compensating for reduced inhibitory neurotransmission, provide some ersatz mechanistic understanding of the syndrome. These treatments that hint at inhibitory involvement include intrathecal baclofen and benzodiazepines [ 290 , 350 ]. Intrathecal baclofen, a GABA-B receptor agonist [ 351 , 352 ] and mediate some GABA-A activation [ 353 , 354 ] has been used to treat spasticity in general [ 355 ] and sCP [ 356 ] since the 1980s.…”

“…Benzodiazepines (most notably diazepam) bind to GABA-A receptors [ 361 ] and reduce muscle spasticity via inhibiting MNs in patients with sCP [ 350 ]. Clinically, improvement post diazepam treatment has been demonstrated [ 362 , 363 , 364 ], with nocturnal dosing helping to avoid daytime sedation [ 364 ].…”

Benefit of enteral baclofen in the management of spasticity in cerebral palsy

“…Baclofen has been used as a mainstay for treatment of spasticity and was approved by the U.S. Food and Drug Administration (FDA) for the same recently on December 7, 2021, in the form of granules [ 2 ]. Though baclofen is not specifically approved by the U.S. FDA for CP-associated spasticity, it has been a first line oral treatment for children with spastic CP since the 1960 s [ 3 ]. Baclofen can be given orally, intravenously, and intrathecally.…”