The use of tiagabine in pediatric spasticity management

Abstract

Tiagabine, developed as an anti-epileptic medication, has the potential to reduce spasticity. The purpose of the present study was to assess the effectiveness of tiagabine in decreasing spasticity and improving the functional abilities of children with spastic cerebral palsy (CP). Nine children (seven females, two males) with CP (six spastic quadriplegia, three moderate to severe spastic diplegia) were treated with tiagabine for a mean of 7.2 months. Median age was 4y 5mo (range 3y 2mo-10y). All children were non-ambulatory. According to the Gross Motor Function Classification System, six were Level IV and three were Level V. Only one child showed a median decrease ≥1.0 grade on the modified Ashworth scale in upper extremities, lower extremities, and overall. Another child had significant improvement in the Pediatric Evaluation of Disability Inventory Self-care score and improved feeding. None of the participants was found to have a significant improvement in motor function or a decrease in the number of motions (passive range of motion and muscle length test) that were limited. Reduction of nocturnal awakenings from painful spasms was reported in one child. Eight of the nine children experienced adverse sideeffects during treatment. Although tiagabine was not found to be effective in decreasing children's spasticity or improving their function, its potential use in the relief of painful spasms associated with neurological conditions in the pediatric population warrants further investigation. Spastic cerebral palsy (CP) is characterized by hyperreflexia, hypertonia, and clonus. Spasticity management has been very challenging and, at the same time, frustrating for clinicians. Oral medications including baclofen, diazepam, dantrolene sodium, and tizanidine have been used.Tiagabine hydrochloride (Leach and Brodie 1998) is a new anti-epileptic medication that prevents the re-uptake of γ-aminobutyric acid (GABA) into presynaptic neurons. This greater availability of GABA for postsynaptic binding leads to increased neuronal inhibition and, theoretically, makes it an effective anticonvulsant and antispasticity agent.Holden and Titus (1999) reported an average improvement of about 50% in the motor function of 14 children with spastic quadriparesis treated with tiagabine for 2 to 6 months. Their evaluation was limited to a pediatric neurologist's estimation of the percentage of change in motor function, on the basis of undefined gross, fine, and oral motor skills.The purpose of the present pilot study was to assess the effectiveness of tiagabine in decreasing the spasticity and improving the functional abilities of children with spastic CP using multidisciplinary standardized evaluations. MethodThe 10 participants (seven females, three males) were selected from the Spasticity Center at the New York University Hospital for Joint Diseases because their spasticity interfered with their function. Median age was 4y 5mo (range 3y 2mo-10y). Six children had spastic quadriplegic CP and four had moderate to severe spastic diplegi...