SPASTIC CEREBRAL-PALSY - APPROACHES TO DRUG-TREATMENT

Spasticity is the most common movement disorder of persons with cerebral palsy, and is attributable to the insufficient release of gamma-aminobutyric acid (GABA) in the spinal cord. The goals of treating spasticity vary, depending on its severity and on the extent of the muscles involved, and should be identified before treatment begins. While surgical/orthopaedic management of spastic cerebral palsy is the most common form of therapy, drug treatment is used to delay or supplement those treatments. The 3 orally administered medications most commonly used to treat spastic cerebral palsy are baclofen, diazepam and dantrolene. These drugs reduce spasticity significantly more than placebo, but their relative ineffectiveness has resulted in an interest in more invasive pharmacological treatments, including intramuscularly administered botulinum toxin and intrathecally administered baclofen. Botulinum toxin acts by preventing the release of acetylcholine from synaptic vesicles at the neuromuscular junction. It significantly reduces hyper tonia in the injected muscles for 2 to 4 months and has virtually no systemic adverse effects. Continuously administered intrathecal baclofen significantly reduces spasticity in the upper and lower extremities of approximately 80% of patients with cerebral spasticity and improves their ability to transfer positions. It is appropriate therapy for patients with suboptimal underlying strength, who rely on some spasticity to stand and be mobile Future evaluation of the active enantiomer, L-baclofen, is anticipated.