The Role of Medication in Treating Cerebral Palsy

Spasticity

For children who experience high levels of spasticity or hypertonia, prescription medication can dramatically improve symptoms.

Pain

Some children experience acute or chronic pain, especially children with spastic CP who often experience worse pain than those with other types of cerebral palsy. Pain is most commonly concentrated in the hips, knees, ankles, and the upper and lower back. Preventive treatment early in life has been shown to help avoid the stress and strain that causes pain.

Seizures

Many children with intellectual disabilities and CP also have epilepsy. Medications called anticonvulsants are prescribed based on the type of seizures a child experiences, since no one drug controls all types of seizures. Sometimes a combination drug approach is recommended to achieve the best seizure control.

Types of Medications

Oral Medications

These are usually the first line of treatment to relax stiff, contracted or overactive muscles. Oral medications are best for children who only need mild reduction in muscle tone or who have widespread spasticity. Some drugs come with the risk of side effects that require monitoring. Be sure to consult with your doctor or pharmacist.

Types of Oral Medications
Antispasticity medications are divided into two groups: antispasmodics and antispastics. Antispasmodics are used to treat muscle spasms, and antispastics are used to treat muscle spasticity.

Antispasmodics – Skeletal muscle relaxants are medications commonly used to treat two different types of conditions: spasticity from upper motor neuron syndromes and muscular pain or spasms from peripheral musculoskeletal conditions. Some of these medications work in the brain to reduce excessive nerve activity, while others act directly on muscles.

Antispastics – Antispastics help reduce muscle spasticity in patients (and are not used to treat muscle spasms). There are a number of types of antispastics available:

  • Muscle relaxants – “Muscle relaxants” are actually not a class of drugs, but the umbrella term covers a variety of different drugs that have an overall sedative effect. Muscle relaxing drugs such as baclofen, diazepam, and dantrolene may be prescribed to reduce spasticity. All of these drugs can be taken by mouth, but baclofen may also be injected directly into the cerebrospinal fluid through an implanted pump.
  • Dopaminergic drugs – This medication, commonly used to treat Parkinson’s disease, raises the body’s dopamine levels, leading to less rigidity and better muscle control.
  • Dantrolene (Dantrium) – Dantrolene helps control chronic spasticity, including that related to spinal injuries. It is also used for conditions such as stroke, multiple sclerosis, and cerebral palsy. Dantrolene is taken as a capsule.
  • Benzodiazepines – Benzodiazepines are used to control muscle spasms and to provide sedation. Barbiturates and benzodiazepines alter GABA receptors which are the major inhibitory neurotransmitter receptors in the brain. Dantrolene and baclofen may also be considered for severe spasticity. Relaxants, such as Valium, work on brain chemistry to ease certain CP conditions. Other examples of oral benzodiazepines are Xanax, Ativan, Librium and Klonopin.
  • Glycopyrrolates –This medication is used to treat Sialorrhea or excessive drooling.
  • Carbamazepines – Antiepileptic drugs (AEDs) are those which decrease the frequency and/or severity of seizures. You may also hear the outdated term, anticonvulsant drug, which is still sometimes used as a synonym for AED, but is less accurate because many seizures do not involve convulsive movements.
  • Proton Pump Inhibitors (PPIs) – Introduced for treatment of gastrointestinal disease, PPIs suppress acid and are used for the treatment of peptic ulcer disease and for severe GERD not responding to other therapy. Several PPI’s–Prilosec, Prevacid and Aciphex–are now marketed for GERD. PPIs were initially recommended for short term use.

Injectable Medications

Botulinum toxin (Botox) is often used to relieve hypertonia in a specific area of the body because its effects are local, not body-wide. It is a neurotoxin, which works by weakening spastic muscles, and causing them to relax. Injected locally, botox has become a standard treatment in children with spastic movement disorders such as CP.

Intrathecal Medications

Intrathecal baclofen therapy uses an implantable pump to deliver baclofen, a muscle relaxant, into the fluid surrounding the spinal cord. Baclofen decreases the excitability of nerve cells in the spinal cord, which then reduces muscle spasticity throughout the body. The pump can be adjusted if muscle tone is worse at certain times of the day or night. The baclofen pump is most appropriate for individuals with chronic, severe stiffness or uncontrolled muscle movement throughout the body.

Questions to Ask Your Doctor

Don’t wait until you’re home with a new prescription to realize you have unanswered questions. Here’s a list of questions you’ll want to ask your physician about a new treatment, medication or surgical intervention BEFORE leaving the doctor’s office!

Always inform the prescribing physician of all other medications and/or treatments your child is receiving, even dietary supplements such as vitamins.

Medications

  • Dosage/Time – As with any medication, you need to know the dosage and how many times per day it needs to be administered.
  • Side Effects – Ask your physician what side effects are associated with any new medication/injections and what adverse side effects warrant concern.
  • Dietary Restrictions – In the case of prescription medications, ask your physician if there are any foods that should be avoided while taking the medication.
  • Take with Food or Without – Some medications need to be taken on an empty stomach while others may need to be taken with food.
  • How Long – How long will your child be on the medication?
  • What happens if a therapeutic dose isn’t effective?
  • Is blood work needed to monitor therapeutic medication levels or other functions (kidney/liver) that may be indirectly impacted by the medication? How often, if needed?
  • Injectable Medications – For injectable medications, ask what can be provided for pain relief, if needed, for the injection site or other discomfort post-treatment.
  • Surgical – With any surgical treatment you should be provided with post-surgical guidelines answering all your questions and contact information, should you need to contact the surgeon or other physician with a concern.

When considering any medical intervention for your child, whether it be prescription medications, therapy or surgery, advice should always be obtained through consultation with a physician who has examined your child and is familiar with your child’s medical history.

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