Abstract:
OBJECTIVE:To evaluate published evidence of efficacy and safety of pharmacologic treatments for childhood spasticity due to cerebral palsy. METHODS:A multidisciplinary panel systematically reviewed relevant literature from 1966 to July 2008. 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. RECOMMENDATIONS:For localized/segmental spasticity that warrants treatment, botulinum toxin type A should be offered as an effective and generally safe treatment (Level A). There are insufficient data to support or refute the use of phenol, alcohol, or botulinum toxin type B (Level U). For generalized spasticity that warrants treatment, diazepam should be considered for short-term treatment, with caution regarding toxicity (Level B), and tizanidine may be considered (Level C). There are insufficient data to support or refute use of dantrolene, oral baclofen, or continuous intrathecal baclofen (Level U).
journal_name
Neurologyjournal_title
Neurologyauthors
Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society.,Delgado MR,Hirtz D,Aisen M,Ashwal S,Fehlings DL,McLaughlin J,Morrison LA,Shrader MW,Tilton A,Vargus-Adamsdoi
10.1212/WNL.0b013e3181cbcd2fsubject
Has Abstractpub_date
2010-01-26 00:00:00pages
336-43issue
4eissn
0028-3878issn
1526-632Xpii
74/4/336journal_volume
74pub_type
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