Updates in the Treatment of Spasticity Associated With Cerebral Palsy.
Summary of "Updates in the Treatment of Spasticity Associated With Cerebral Palsy."
Spasticity affects up to 80 % of patients with cerebral palsy (CP) and often plays a significant role in limiting the child's ability to function and participate in daily activities. The treatment of spasticity involves a multifaceted approach that includes pharmacological treatment with antispasmodics, physical therapy to maintain range of motion and prevent contractures, as well as a variety of orthopedic and neurosurgical interventions. Pharmacological agents currently used in clinical practice to treat spasticity in children have existed for almost two decades and continue to be used despite lack of solid evidence for their efficacy. Studies detailing safety profiles and optimal dosing in the pediatric population are greatly warranted. Intramuscular injection of botulinum neurotoxin is becoming increasingly popular for the treatment of segmental spasticity and current literature suggests it is safe and effective (Level A). Constraint-induced movement therapy (CIMT) and repetitive transcranial magnetic stimulation (rTMS) are emerging as effective interventions in improving motor function in hemiplegic CP. However, the role of these as of yet >interventions in reducing spasticity remains to be clarified.
Division of Pediatric Neurology, Montreal Children's Hospital-McGill University Health Center, McGill University, Montreal, Quebec, Canada.
This article was published in the following journal.
Name: Current treatment options in neurology
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22851256
- DOI: http://dx.doi.org/10.1007/s11940-012-0192-7
Medical and Biotech [MESH] Definitions
A heterogeneous group of nonprogressive motor disorders caused by chronic brain injuries that originate in the prenatal period, perinatal period, or first few years of life. The four major subtypes are spastic, athetoid, ataxic, and mixed cerebral palsy, with spastic forms being the most common. The motor disorder may range from difficulties with fine motor control to severe spasticity (see MUSCLE SPASTICITY) in all limbs. Spastic diplegia (Little disease) is the most common subtype, and is characterized by spasticity that is more prominent in the legs than in the arms. Pathologically, this condition may be associated with LEUKOMALACIA, PERIVENTRICULAR. (From Dev Med Child Neurol 1998 Aug;40(8):520-7)
Degeneration of white matter adjacent to the CEREBRAL VENTRICLES following cerebral hypoxia or BRAIN ISCHEMIA in neonates. The condition primarily affects white matter in the perfusion zone between superficial and deep branches of the MIDDLE CEREBRAL ARTERY. Clinical manifestations include VISION DISORDERS; CEREBRAL PALSY; PARAPLEGIA; SEIZURES; and cognitive disorders. (From Adams et al., Principles of Neurology, 6th ed, p1021; Joynt, Clinical Neurology, 1997, Ch4, pp30-1)
A familial, cerebral arteriopathy mapped to chromosome 19q12, and characterized by the presence of granular deposits in small CEREBRAL ARTERIES producing ischemic STROKE; PSEUDOBULBAR PALSY; and multiple subcortical infarcts (CEREBRAL INFARCTION). CADASIL is an acronym for Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy. CADASIL differs from BINSWANGER DISEASE by the presence of MIGRAINE WITH AURA and usually by the lack of history of arterial HYPERTENSION. (From Bradley et al, Neurology in Clinical Practice, 2000, p1146)
Diffuse Cerebral Sclerosis Of Schilder
A rare central nervous system demyelinating condition affecting children and young adults. Pathologic findings include a large, sharply defined, asymmetric focus of myelin destruction that may involve an entire lobe or cerebral hemisphere. The clinical course tends to be progressive and includes dementia, cortical blindness, cortical deafness, spastic hemiplegia, and pseudobulbar palsy. Concentric sclerosis of Balo is differentiated from diffuse cerebral sclerosis of Schilder by the pathologic finding of alternating bands of destruction and preservation of myelin in concentric rings. Alpers' Syndrome refers to a heterogeneous group of diseases that feature progressive cerebral deterioration and liver disease. (From Adams et al., Principles of Neurology, 6th ed, p914; Dev Neurosci 1991;13(4-5):267-73)
A centrally acting muscle relaxant that has been used for the symptomatic treatment of spasticity and muscle spasm. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1211)
Purposes. To investigate the relationship between associated reactions and a) spasticity, b) contracture and c) coordination. Methods. Associated reactions were measured as magnitude of muscle activit...
BACKGROUND: Gait in young people with cerebral palsy is inefficient and there is a lack of relevant indicators for monitoring the problem. In particular, the impact of gait kinematics on gait efficien...
Objective: To conduct a systematic review using validated critical appraisal scales to analyze both the quality and content of the psychometric evidence of spasticity measurement tools in cerebral pal...
Aim The aim of this study was to evaluate the long-term effects of selective dorsal rhizotomy (SDR) in children with cerebral palsy (CP). Method Nineteen children (four females, 15 males; mean a...
Botulinum neurotoxin type-A (BoNT-A) has been used in association with other interventions in the management of spasticity in children with cerebral palsy (CP) for almost two decades. This consensus s...
Evaluation of the effect of intrathecal administration of Baclofen on spasticity of cerebral palsy patients, by means of standardized and internationally accepted scales
The objective of this study is to determine the efficacy and safety of treatment with intrathecal baclofen for severe spasticity in children with cerebral palsy.
The objective of this study is to gain more knowledge about the association between muscle weakness, spasticity and motor control in children with cerebral palsy, and its relationship to h...
This study examines botulinum toxin (BOTOX, or BTX) for the treatment of muscle twitches and spasticity associated with cerebral palsy in children. Botulinum toxin is a naturally occurring...
Oral baclofen is used commonly to treat spasticity in children with cerebral palsy. Although for adults there is dosing,safety and efficacy information in the package insert, this is not t...