Content provided by American Academy of Neurology
(ARA) - A diagnosis of cerebral palsy can fill parents with fear about their child's quality of life and confusion about how to treat this complex neurological disorder.
Cerebral palsy will affect more than 10,000 babies born in the United States this year. This disorder affects body movement and posture. One of the major symptoms is spasticity, which is associated with muscle weakness and abnormal reflexes.
Spasticity can affect hip adductor muscles, cause painful muscle cramps or even force a person with cerebral palsy to walk on her toes - which increases the potential for the person to trip and fall.
Cerebral palsy can't be cured, but treatment does help many people with this condition live easier, better quality lives.
"Spasticity in children with cerebral palsy is best treated by a multidisciplinary medical and surgical team," says Dr. Mauricio R. Delgado, lead author of the American Academy of Neurology's (AAN) new guideline on treating spasticity in children with cerebral palsy.
The team can include a neurologist, developmental pediatrician, physiatrist, orthopedist, physical therapist, occupational therapist, speech therapist, an orthotist and other specialists. Families with someone who has cerebral palsy can find these teams across the country in centers that specialize in cerebral palsy. Contact the national United Cerebral Palsy Association at ucp.org to find these centers.
The AAN's new guideline reports botulinum toxin type A was found to be an effective treatment for spasticity, but can pose some risk. For more information about the Academy, visit www.aan.com.
"In reviewing this drug for treatment of spasticity in children, the Food and Drug Administration is investigating isolated cases of generalized weakness following use of botulinum toxin type A for spasticity," Delgado says. "A family should weigh the benefits against potential risks for any treatment that is presented. There needs to be a clear goal of what is to be achieved by the treatment."
He recommends people with cerebral palsy and their parents or caregivers work with the medical team and set goals to measure the success of medications and treatments. For example, reducing spasticity in hip adductor muscles can improve hygiene and ease of diaper changing, or reducing spasticity in the calf muscles can help the affected person walk on the full foot instead of just the toes.
When her daughter was diagnosed with cerebral palsy at the age of 3, Karen Knoch of Flower Mound, Texas, says her daughter - now 10 - could walk with a bit of hobble. They started working with a team of doctors at Scottish Rite Hospital for Children in Dallas, who monitored the muscle tightness in her daughter's right leg. But at the age of 7, her daughter started experiencing severe pain, first in one foot and then in both.
"We needed to start addressing the underlying issues, the tight muscles," Knoch said. "They started talking about heel cord lengthening and muscle transfer surgery."
But then Dr. Delgado was brought onto the team, and everyone determined a botulinum toxin type A treatment would be less invasive and probably the best solution for her daughter. She received one injection and wore a brace for three years, and this year finished in the middle of the pack in her school's Jingle Bell Jog, an annual running event where students in each grade level run a specific distance.
"It was really neat to show her and tell her the progress she's made," Knoch said. They're still monitoring her daughter's progress, because her body is still growing. "She's 10, and over the next two to three years, she's going to be going through puberty, and her body's going to be changing. This is the key time where a lot more can be happening. As her bones grow, her muscles might not grow with them - which might make her a candidate for another injection."
Botulinum toxin type A treatments are typically used in children ages 2 to 7, and surgical treatments are considered for children 7 to 8 years old because surgery can give longer-lasting results. "We do not like to use surgical treatments in the young child because of the risk of recurrence," Delgado says.
The AAN guideline also recommends that doctors consider the drug diazepam for short-term treatment of spasticity and the drug tizanidine, but there is a risk of liver toxicity with tizanidine.
"There is an urgent need for more research to establish the effectiveness of the current treatments for generalized spasticity and to find additional, safer and more effect medications," says Delgado.
Courtesy of ARAcontent
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