Practice Parameter: Pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review)

Abstract

Objective: To evaluate published evidence of efficacy and safety of pharmacologic treatments for childhood spasticity due to cerebral palsy. Results: For localized/segmental spasticity, botulinum toxin type A is established as an effective treatment to reduce spasticity in the upper and lower extremities. There is conflicting evidence regarding functional improvement. Botulinum toxin type A was found to be generally safe in children with cerebral palsy; however, the Food and Drug Administration is presently investigating isolated cases of generalized weakness resulting in poor outcomes. No studies that met criteria are available on the use of phenol, alcohol, or botulinum toxin type B injections. For generalized spasticity, diazepam is probably effective in reducing spasticity, but there are insufficient data on its effect on motor function and its side-effect profile. Tizanidine is possibly effective, but there are insufficient data on its effect on function and its side-effect profile. There were insufficient data on the use of dantrolene, oral baclofen, and intrathecal baclofen, and toxicity was frequently reported. Methods:

Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache

“…A 2010 AAN guideline provides recommendations for BoNT treatment of spasticity in pediatric patient populations, 29 and therefore this review discusses only adult spasticity.…”

A Review on Stem Cell Therapy in Cerebral Palsy with a Focus on Motor Function Improvement

“…A large part of physical disabilities can be improved by rehabilitation therapy. Some medications are also indicated to relieve seizures and movement difficulties (9). In some cases, neurosurgical and orthopedic surgical interventions could be helpful (10).…”

Reducing severe spasticity in cerebral palsy following meningoencephalitis by botulinum toxin

“…The best evidence of Botox usage is for equinus varus treatment. 3,4 The effects of Botox can be seen on spasticity, range of motion (ROM), gross motor function, and gait improvement. 5,6 The aim of this paper is to report the effectivity of botulinum toxin in the management of severe spasticity in a child with spastic diplegia CP following meningoencephalitis.…”