Cerebral Palsy Drug Therapies

The term "Cerebral Palsy" does not express a strict diagnosis for a single well-defined childhood disease, but is rather a loose description applied to a constellation of disorders (e.g., motor deficits such as paralysis, incoordination, and involuntary movements as well as seizure activity and visual difficulties) occurring in children.

While the etiology of Cerebral Palsy is difficult to establish, prenatal abnormalities, birth trauma, neonatal asphyxia, and neonatal jaundice have been implicated as causal factors. Unfortunately, it is only rarely possible to establish that a child is suffering from Cerebral Palsy during early infancy. Nevertheless, children known to be at unusual risk due to any of the aforementioned prenatal and neonatal conditions should receive close follow-up surveillance, as the prognosis for future optimal functioning depends on early detection and institution of multidisciplinary services.

In treating Cerebral Palsy, the goal is to develop and maintain maximal independence within the limits of the patient’s specific motor and associated handicaps. The gold standard in the management of motor spasticity and seizure activity is the use of anticonvulsants and sedatives. Diazepam, Baclofen, Flexeril, and Dantroline are among the most effective anticonvulsant and tranquilizing agents for chronic use in children and adolescents with Cerebral Palsy. These medications work directly on the brain by slowing nervous system transmissions at the level of the spinal cord, thereby relaxing spastic muscles, controlling adventitious movements, and preventing seizures. Although therapeutic and toxic blood levels are reasonably well-established for these agents, undesirable side effects such as drowsiness, irritability, nausea, vomiting, rash, and confusion are still possible. Injectible Botox can also be used to control muscle spasms especially of the eyes, face, and neck in persons with Cerebral Palsy. However, its effects are temporary and it is not without some side effects including difficulty swallowing, generalized malaise, droopy eyelids, and double vision. Injectible alcohol, known as an alcohol “wash,“ can also target specific muscle groups and ease spasms but, like injectible Botox, its therapeutic effect is also temporary. Alternatively, dopaminergic medications such as Sinemet and Artane, which have long been preferred treatments for Parkinson’s Disease, are showing promise in treating spasms in children with Cerebral Palsy. Treatment with these agents should be started as early in life as is possible, as they are known to cause serious side effects such as exacerbation of muscle stiffness and tremor, dizziness, confusion, sleeplessness, and hallucinations in older people. In addition, longitudinal studies have not been conducted on these medications, so their long-term risks and benefits are not yet understood.

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We were there as medical students - at labors and deliveries, following fetal monitor tracings and witnessing how birth complications can develop - and how the attending doctors and nurses dealt with the Spastic Cerebral Palsy issues. We've done rotations through pediatrics, obstetrics, radiology, and neurology as well, and therefore understand the normal developing fetus and baby from one with problems or potential identifiable Athetoid Cerebral Palsy difficulties.

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