Dystonic Cerebral Palsy Treatments


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Click here to read about physiotherapy, occupational therapy and speech and language therapy in treating dystonic cerebral palsy.

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Medication

Medication is often used to manage the muscle spasms and pain. If your child's muscles are particularly stiff and overactive, they may need medication to help relax their muscles. Many people with cerebral palsy also experience a lot of pain associated with gastrointestinal problems including gastric reflux and reduced gut motility causing constipation; these symptoms, which can also aggravate the symptoms of dystonia, can be eased using medication.

The principle of the use of medication in managing cerebral palsy is to help with the symptoms. If it does this with manageable side effects then they will be continued but if they are not helping or the side effects are intolerable then they should be discontinued and alternative treatments tried or considered.

All medications can have side effects which need to be discussed carefully with your child’s doctor before starting. All decisions relating to increasing or reducing medication dosage also need to be done in consultation with the doctor responsible for your child’s care before any change is made.  

1. Trihexyphenidyl also known as broflex and benzhexol is a member of the anticholinergic family of drugs used to control muscle spasm and tremor by blocking a chemical messenger in the brain called acetylcholine. In dystonic cerebral palsy it may help arm, leg and mouth function and can reduce the excessive salivation that some with dystonic cerebral palsy experience.

This drug can cause side effects such as dry eyes, mouth and gastro-intestinal disturbances, particularly constipation, urinary retention, blurred vision and behavioural disturbances.

Trihexyphenidyl often has to be used in very high doses - starting on a low dose and gradually increasing until the best effect is achieved with the least side effects. If the side effects become intolerable then the dose may have to be reduced or the drug stopped. All changes in dose need to be done under the supervision of the responsible doctor. It is important that this drug is not suddenly stopped without supervision as it may cause a significant increase in symptoms.

2. Muscle relaxants Your child may be prescribed muscle relaxant medicine such as diazepam, which is can be taken in tablet or liquid form.

Side effects of diazepam include drowsiness, slurred speech, constipation, nausea and incontinence. If diazepam is not effective, a number of alternative muscle relaxants can be used.

3. Baclofen & Clonidine may be used orally to relieve the symptoms of spasticity. High doses may be required to achieve the optimal effect and it may be a compromise of relief of symptoms and tolerable side effects.

Side effects of Baclofen are: low blood pressure, muscle weakness, drowsiness, dizziness, insomnia, bowel and urinary problems, nausea, headache and confusion.

Side effects of Clonidine include dizziness associated with postural changes, dry mouth, constipation, nausea, daytime sleepiness, weakness, and lethargy. Dermal patches may cause rashes, hair loss, a burning sensation on the skin, or other skin irritations where the patch is applied. Changing to tablets may not resolve the problem.

4. Tetrabenazine is a member of the antidopaminergic family of drugs which work by suppressing the release of chemical messengers in the brain such as dopamine and serotonin. These drugs are used to control tremor and involuntary spasms or movements; in the case of dystonic cerebral palsy they help with the hyperkinetic symptoms such as chorea.
This drug can have some side effects including restlessness (akathisia), depression, dizziness, drowsiness, gastro-intestinal disturbances, low blood pressure.

Occasionally it can cause high temperature combined with reducing consciousness, pale, sweaty, fast heart rate – this needs immediate medical attention.

5. Botulinum toxin injections into the muscles can be used if muscle relaxants are not effective or if particular muscle groups are affected by the dystonia. It works by blocking the signals from the nerve endings to the affected muscles.

The effects of the injection normally last for up to three months. The treatment is most effective when a programme of stretching and physiotherapy follows the injections.

6 Drugs used to manage gastric reflux include feed thickeners; domperidone to increase gut motility which speeds up the passage of food; and drugs to reduce stomach acid production.

Other treatments

1. Intrathecal baclofen is usually used when oral medication is not effective or tolerated. It involves surgically implanting a small pump under the abdominal wall that is connected to the spinal cord. The pump delivers a steady dose of baclofen, directly into the nervous system. Baclofen blocks some of the nerve signals that cause muscle stiffness. Baclofen can be used orally but the large doses required may lead to unpleasant side effects.

2. Orthopaedic Surgery may be needed to manage limb deformities and spasticity particularly in those with GMFCS of 4-5. It is used to correct problems with bones and joints. It may be recommended if your child's cerebral palsy is causing them pain when they walk or move around or there is increased deformity. It can also improve their posture and mobility skills, which may improve their confidence and self-esteem. It is only carried out if therapy is not improving function sufficiently and it is a decision of the multidisciplinary team in discussion with the child and the family. Surgery is not always appropriate. 

During surgery, the surgeon will lengthen any muscles and tendons that are too short and are causing problems. Surgery is not always beneficial in dystonic cerebral palsy so its use should be treated with caution after full discussion and should carried out by an experienced orthopaedic surgeon.

Surgical procedures are normally staggered over your child's life, taking into account their likely physical development.

3. Deep Brain Stimulation is not usually effective for those with athetoid or dystonic cerebral palsy but is sometimes appropriate.

Some alternative therapies such as yoga and massage can be helpful but should be used in conjunction with conventional treatments and not instead of.

Click here to return to main dystonic cerebral palsy page.

Last reviewed March 2014

Disclaimer
The Dystonia Society provides the information on this page as general information only. It is not intended to provide instruction and you should not rely on this information to determine diagnosis, prognosis or a course of treatment. It should not be used in place of a professional consultation with a doctor.
The Dystonia Society is not responsible for the consequences of your decisions resulting from the use of this information, including, but not limited to, your choosing to seek or not to seek professional medical care, or from choosing or not choosing specific treatment based on the information. You should not disregard the advice of your physician or other qualified health care provider because of any information you receive from us. If you have any health care questions, please consult the relevant medical practitioner.

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