RT Journal Article
SR Electronic
T1 Practice Parameter: Pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review)
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 336
OP 343
DO 10.1212/WNL.0b013e3181cbcd2f
VO 74
IS 4
A1 M. R. Delgado
A1 D. Hirtz
A1 M. Aisen
A1 S. Ashwal
A1 D. L. Fehlings
A1 J. McLaughlin
A1 L. A. Morrison
A1 M. W. Shrader
A1 A. Tilton
A1 J. Vargus-Adams
YR 2010
UL http://n.neurology.org/content/74/4/336.abstract
AB 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). AAN=American Academy of Neurology; AE=adverse event; AS=Ashworth scale; BoNT-A=botulinum toxin type A; BoNT-B=botulinum toxin type B; CP=cerebral palsy; FDA=Food and Drug Administration; GAS=Goal Attainment Scale; GMFM=Gross Motor Function Measure; ITB=intrathecal baclofen; MAS=Modified Ashworth scale; OT=occupational therapy; PT=physiotherapy; QUEST=Quality of Upper Extremity Skills Test; TS=Tardieu scale.