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One of the major characteristics of cerebral palsy is spasticity, meaning that the muscles are stiff or rigid muscles. It also describes stiff, rigid muscles interfering with normal muscle activity, movement, walking or speaking. If muscles or tendons remain tense for too long, joints become bent in a fixed rigid position called a contracture.Spasticity is caused by damage to the portion of the brain that controls voluntary movements. The motor area of the brain is found in the cerebral cortex. If this portion of the brain is damaged, it can affect how nerve impulses from the brain are carried along the spinal cord and through the nervous system to the muscles and tendons. These interrupted or abnormal messages can cause hyperactive deep tendon reflexes, causing knees to jerk, legs to scissor (open and close like a pair of scissors), and repetitive, or jerky motions.
Interrupted or irregular nerve impulses can also cause individuals with diseases like cerebral palsy, or with brain injuries, to hold their shoulders, arms or fingers in odd ways. Spasticity can be extremely debilitating and painful. It is also common in brain injured individuals. Common treatments for spasticity include physical therapy, medications and surgery.
Drugs are sometimes used to control spasticity, particularly following surgery. The three medications that are used most often are diazepam, which acts as a general relaxant of the brain and body; baclofen, which blocks signals sent from the spinal cord to contract the muscles; and dantrolene, which interferes with the process of muscle contraction. Given by mouth, these drugs can reduce spasticity for short periods, but their value for long-term control of spasticity has not been clearly demonstrated. They may also trigger significant side effects, such as drowsiness, and their long-term effects on the developing nervous system are largely unknown.
Patients with athetoid cerebral palsy may sometimes be given drugs that help reduce abnormal movements. Most often, the prescribed drug belongs to a group of chemicals called anti-cholinergics that work by reducing the activity of acetylcholine. Acetylcholine is a chemical messenger that helps some brain cells communicate and that triggers muscle contraction. Anticholinergic drugs include trihexyphenidyl, benztropine, and procyclidine hydrochloride.
Occasionally alcohol "washes" -- or injections of alcohol into a muscle Ç are used to reduce spasticity for a short period. This technique is most often used when physicians want to correct a developing contracture. Injecting alcohol into a muscle that is too short weakens the muscle for several weeks and gives time to work on lengthening the muscle through bracing, therapy, or casts. In some cases, if the contracture is detected early enough, this technique may avert the need for surgery.
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The following are a list of the most frequently used
antispasmodic drugs used to treat cerebral palsy:
What is Baclofen?
Baclofen, (Lioresol ), was introduced in 1967 as an oral medication for the treatment of muscle spasticity. It is a muscle relaxant, frequently prescribed to treat cerebral palsy, multiple sclerosis and spinal cord injuries. In 1996 the FDA approved an injectable form of Baclofen which is given through an intravenous pump into the spinal cord.How is it given?
For more information about Baclofen therapy, see the following links:
It can be given either by mouth or injected directly into the spinal cord (intrathecal injection).
- How can it help?
Baclofen can provide long-term reductions in muscle spasticity. This may help improve movement, speech, swallowing and alertness. Baclofen works more rapidly and effectively when injected directly into the spine.
- What are the side effects?
Side-effects of Baclofen include dose-related sleepiness, nausea, headache, muscle weakness and light headedness. Those who have had catheters surgically implanted for injection can experience infection at the catheter site. Most side effects are temporary and can be eliminated by modifying medication doses.
- Intrathecal Baclofen Therapy for Treating Cerebral Palsy Cleared by FDA
- Individual Experiences with Baclofen
- Baclofen: Drug Monograph from RxList:
- An Overview of Baclofen for Health Professionals
- Medline Information about Baclofen
- An Introduction to Intrathecal Baclofen
- Caring for an Intrathecal Baclofen Pump
- Use of Intrathecal Baclofen Therapy in Management of the Brain Injured Patient
- Intrathecal Baclofen Infusion Pump for Dystonia: Research Project
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What is Dantrolene?
Dantrolene, or Dantrium, is a muscle relaxant that works by blocking the muscles' ability to contract. It is prescribed to treat muscle spasms caused by cerebral palsy, spinal cord injuries and multiple sclerosis. It is also used to treat malignant hyperthermia, a rise in body temperature caused by anesthesia.
- How is it given?
Dantrolene is given most frequently in oral form, however other methods may be used in operating room settings.
- How can it help?
Dantrolene can help relieve severe muscle spasms and bring pain relief and increased movement.
- What are the side effects?
Dantrium may cause serious liver damage and disease, including hepatitis and jaundice. Liver function testing should be performed before starting this medication. The most common side effects include diarrhea, dizziness, drowsiness, fatigue, vague feeling of illness, and weakness. Drinking alcohol while on Dantrium can increase symptoms of drowsiness and dizziness. Also, taking this drug with other medications, like antidepressants, antihistamines, sedatives and tranquilizers can be dangerous. Dantrolene has not been approved for use in children under age 5, and is not approved for use by pregnant women.For more information on Dantrolene see the following links:
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What is Botox?Botox is the Botulinum toxin, which causes food poisoning. Botox injections are commonly used in cosmetic surgery to reduce wrinkles. These injections were first used to treat muscle spasm in people with hemifacial spasms. It was observed during this treatment that the injections reduced facial wrinkles. Recent clinical studies have shown that injecting Botox into the spastic muscles of cerebral palsy sufferers can bring relief by causing the muscles to relax.
For more information about Botox, see the following links:
- How is it given?
A small needle is used to inject BOTOX directly into the spastic muscle. Dosage is based on body weight. The injection is relatively painful and requires no anesthesia.
- How can it help?
Botox injections usually help reduce muscle spasticity, and can help support physical therapy. The effects of a Botox injection into a muscle usually last for approximately 12 weeks, after which time another injection is needed. If enough relaxation occurs following an injection, doctors may splint the limb, hoping to create a more permanent increased range of motion.
- What are the side effects?
People sometimes experience headache or muscle aches after an injection. Botox cannot be used during pregnancy, or if someone is nursing.
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What is Flexeril? Flexeril is a muscle relaxant that works by blocking the nerve impulses the body sends to the brain. This drug is most commonly, prescribed for short-term use for those with muscle injuries or spasms. It is occasionally ordered for cerebral palsy sufferers, but not frequently.For more information about Flexeril see the following links:
- How is it given?
Flexeril is most often given orally.
- How can it help?
Flexeril is not a popular choice among physicians for reducing spasticity in cerebral palsy. However, it reduces muscles spasms and spasticity by blocking nerve impulses to the brain, which in turn sends out signals for the muscle to contract.
- What are the side effects?
Side effects include drowsiness, dizziness and insomnia.
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Cerebral palsy is often associated with seizures. Seizures can be noticed when there is an uncontrolled contraction of muscles in an area of the body. A seizure can also be recognized by a small moment of "black out" that can seem like daydreaming. Seizures are most frequently caused by injury to the brain, brain tumors, low blood sugars, as can happen in diabetes, high fevers, and in epilepsy.Below is a list of common anti-seizure medications used to treat seizure disorders. For more information on the causes, symptoms and types of seizures, see the following link:
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What is Depakene?Also known as Valproate and Valrelease, Depakene is an anti-seizure medication. How exactly it works is unknown. Depakene can be used to treat both petit mal and grand mal seizures.
For more information about Depakene see the following links:
- How is it given?
Depakene can be given in tablet or liquid form.
- How can it help?
Depakene can help control and eliminate seizures.
- What are the side effects?
Depakene should not be used by anyone with liver disease. Liver function studies should be performed at regular intervals while on this drug. Depakene can enhance the effects of alcohol and other drugs that depress the central nervous system. The most commonly reported adverse reactions are nausea, vomiting, and indigestion.
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What is Diazepam?Also known as Valium, Diazepam is a sedative, anti-convulsant, and muscle relaxant. It is often used to relieve anxiety and as an anesthetic for minor surgeries. It can also be used to relieve seizures.
For more information on Valium see the following links:
- How is it given? Valium can be given orally, intramuscularly or by intravenous injection. It can also be given rectally.
- How can it help?
Valium can be used to help control seizures and to help relieve muscle spasms and spasticity in cerebral palsy sufferers.
- What are the side effects?
Side effects include drowsiness, lethargy, depression, and headache. Valium can also cause confusion and dizziness, as well as respiratory depression.
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What is Dilantin?Dilantin is a medication used to prevent and control seizures. It is used frequently for the control of the type of seizures seen in epilepsy.
For more information see the following links:
- How is it given?
Dilantin can be given by mouth, in an injection or intravenously. It is also available as a liquid for those who have difficulty swallowing.
- How can it help?
Dilantin can help slow, control or stop seizures.
- What are the side effects?
Side effects of Dilantin include drowsiness and dizziness. Other side effects include upset stomach, sleep disturbances and headaches. Caution should be used driving or doing any activity which requires alertness while on Dilantin.
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What is Epival?Epival is a drug that can be used to help control seizures. Exactly how it does that is unclear. It can be used to treat both petit mal and grand mal seizures. It can also be used to treat bipolar disorder.
For more information see the following links:
- How is it given?
Epival can be given by mouth.
- How can it help?
Epival can help control or eliminate seizures.
- What are the side effects?
Epival should not be used by anyone who has liver disease. It should also not be given to children under age 2, and caution should be used in using this drug for children under age 10. Because this drug can cause blood disorders, frequent monitoring of blood counts while taking Epival is important. Anticoagulants, like aspirin and coumadin, should be avoided while taking Epival.
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What is Klonopin?Also called Rivotril, Klonopin is an anticonvulsant drug used to treat petit mal and minor motor seizures. It can be used alone or with other seizure medications.
For more information about Klonopin see the following links:
- How is it given?
Klonopin is given by mouth in capsule form.
- How can it help?
Klonopin can help control minor seizures and may be used to enhance the effects of other seizure medications.
- What are the side effects?
Klonopin should not be used by anyone with liver disease or who has glaucoma. The most frequent side effects include drowsiness, behavior changes, and increased salivation.
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What is Tegretol?Tegretol is used to treat different types of seizures. It can also be used to treat pain caused by nerve damage or disorders. It is also sometimes used to help treat mood disorders. Tegretol is most effective when used to treat generalized tonic-clonic seizures. These are the type of seizures during which the person loses consciousness in association with stiff or jerking extremities.
For more information about Tegretol see the following links:
- How is it given?
Tegretol is available in both tablet and liquid form for those who have difficulty swallowing.
- How can it help?
Tegretol can help control or eliminate seizures. It can also help relieve pain caused by neurological problems.
- What are the side effects?
Side effects include swelling, increased blood pressure, and slurred speech. Tegretol can also cause leg cramps and dry mouth.
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What is Zarontin?Zarontin is a drug used to control petit mal seizures.
For more information about Zarontin see the following links:
- How is it given?
Zarontin can be taken in both capsule and liquid form.
- How can it help?
Zarontin can help control or eliminate petit mal seizures.
- What are the side effects?
Common side effects include dizziness, drowsiness, and lethargy, as well as stomach upsets.
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Program Director, Continuum Center for Health and Healing,
Beth Israel Hospital / Albert Einstein School of Medicine
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