medical management of spastisitiy in cp

[spandanphysio]

hello friends can any1 put more light weather muscle relaxant should be used in spastic,dystonic babies?which 1 should be prefered phenol block or botulin in older ones if it's desirable?which 1 is more adverse affecting?what r the recent options in u r region?pls put u r opinions....

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[estherderu]

dear Spandanphysio,

I sincerely hope and expect that paediatricians and other specialists treating young infants know what they are doing. There will be differences of opinion. Sometimes, treatment can even be a question of money Y/N
The only thing we, as physiotherapists can do is ASK in the event of not understanding the medical management of the child we are helping. With the very young infants, normal management is teamwork so that cannnot be a problem.

We, as health professionals, should try our best to stay informed and we can expect the same of the specialist. Teaching parents to ask questions is also a something I always do as well. There are so many websites these days, patients are becoming better informed and it is their child.

Some fo the best sites on research and evidence are
UCP: Home Page CPI Research Foundation | hope through research AACPDM Home
Children's Hemiplegia and Stroke Association - Support for children with hemiplegia, hemiparesis, childhood stroke, infant stroke, hemiplegia, hemiparesis, neonatal stroke, brain bleed, stroke in utero http://www.scope.org.uk/ Bobath Centre - Cerebral Palsy Treatment
please do not forget CanChild Centre for Childhood Disability Research for lots of current scientific data as well
and of course, for practical information Global-HELP : Non-Profit Low-Cost Health Publications

kind regards

Esther de Ru

[Bobby Nabeyama]

Intrathecal baclofen pump (ITB) therapy is at the cusp of being the preferred management for spasticity in mutiple populations including cerebral palsy. Well, it's not that simple. Obviously, the discriminative patient selection criteria exists including amount body mass, severity of spasticiy, diffuse vs localized spasticity, orthopedic misalignments, selective motor control, muscle strengh, social supports, etc. The evidence for efficacy continues to amount with ITB over localized management such as Botox and phenol blocks.

[spandanphysio]

hi evry1.esterduru u have posted links of many assosiations which puts very little light on my questions.what about side effects of commonly used drugs such as resperidol,syndopa,titaniun dioxide etc. if used for prolong time in child

[estherderu]

dear colleague,
I am not a doctor, know little about medication..... after googling the medication you named I find information that has very little to do with CP.????
eg. are:

How safe is resperidol for children? - Autism - Mental and behavioral health Community - Forum - Revolution Health

PatientsLikeMe : Carbidopa-levodopa

you state" what about side effects of commonly used drugs such as resperidol,syndopa,titaniun dioxide etc. if used for prolong time in child " BUT
I had never heard of these medications before.

In Physical Therapy of Cerebral Palsy , Freeman Miller, the medication named are: baclofen,diazepam,cholrazepate, clonazepam, ketazolam, tetrazepam,dantrolene, tizanidine, clonidine, cannabis, cyclobenzapine. Side effects vary and medication is not always indicated.

In Physical Therapy for Children Campbell,VanderLinden & Palisano I find no reference on medication for CP. For asthma, CF, JVA and spinalcord injuries yes, for CP, non.
??
I have never had a young patient with type of medication you mention.

Is it possible that the reason you did not find much information on the sites I gave you is because these types of medication are not used much????


Esther

[spandanphysio]

hi esterderu the drugs i have mentioned here used commonly here by peadiatric neuros.they used even in very high doses.but speaks a little regarding side effects.also they r using resperidole in cps without autisum also.as a very imp. part of cps rehab. programe v should know about basic drugs used commonly in our rigeon for such childs,that's y i ask about it.and yes what about botulin and phenol which 1 is used in u r region?or any another suppliment?

[estherderu]

dear spandanphysio

I suggest you ask the experts....https://www.cpirf.org/ This research site should be able to tell you more.

AND I would certainly want to ask the doctors concerned! Let them inform you. Let them give you statistics and research information. Do they know what they are doing? and can they inform you and answer your questions?

There are numerous articles about botox, other medication and protocols for treating children with CP. I only know about the situation in Holland and Spain and the ideas differ in both countries.

I personally feel that many doctors are often much too "happy to prescribe" all kinds of medication and a little less happy to educate and explain to parents. You cannot ask enough questions in my opinion. Let them do the work and make sure you know as much as possible. They are prescribing this "poison".... for how long and how often..... they have to "sell you the story and explain why this is the best or only option".

Good luck with your research. Sorry, I cannot answer all your questions.


Esther

[swati]

hi,
i have worked in this field 4 over 5 yrs, but never come across d prescription mentioned by you 4 children with spasticity or dystonia. in bombay where i worked for 4 yrs, the common medications used were baclofen and pacitane,for spasticity and dystonia respectively. also botox or its cheaper substitute phenol are used when you need to target more localized areas of spasticity as there is an optimal dose that one can give of medicines without causing a generalized low tone in the trunk muscles. with botox one can seectively target the spastic muscle groups,viz-TA,hams,adductors,hip flexor. the side-effects of these medicines are well documented. as for intra-thecal baclofen, that is used in children with severe spasticity,and as the absorption of liofen is in small percentage when taken orally.

i'd like to add here that even though we happen to be from the same geographical location,there is no standard protocol in interventions. would like to see a day,when globally in urban or rural scape we can see more evidence based best interventions in use. to that effect this forum helps in bringing updates of our field in easy reach.