Treatments and drugsBy Mayo Clinic staff
Children and adults with cerebral palsy will require some degree of long term care with a medical care team. This team may include:
- Pediatrician or physiatrist, who oversees the treatment plan and medical care
- Pediatric neurologist, who specializes in the diagnosis and treatment of neurological disorders in children
- Orthopedist, who treats muscle and bone disorders
- Occupational therapist, who specializes in therapy to develop everyday skills and to use adaptive products that help with everyday activities
- Developmental therapist, who specializes in therapy to help your child develop age-appropriate behaviors, social skills and interpersonal skills
- Mental health provider, such as a psychologist or psychiatrist
- Social worker, who assists the family with accessing services and planning for transitions in care
- Special education teacher, who addresses learning disabilities, determines educational needs and identifies appropriate educational resources
Medications that can lessen the tightness of muscles may be used to improve functional abilities, treat pain and manage complications related to spasticity. It's important to talk about the risk of drug treatments with your doctor and discuss whether medical treatment is appropriate for your child's needs. The selection of medications depends on whether the problem affects only certain muscles (isolated) or the whole body (generalized). Drug treatments may include the following:
- Isolated spasticity. When spasticity is isolated to one muscle group, your doctor may recommend injections of onabotulinumtoxinA (Botox) directly into the muscle, nerve or both. Severe weakness is a possible side effect. There also is some evidence of more-serious side effects, including difficulty breathing and swallowing.
- Generalized spasticity. If the whole body is affected, oral muscle relaxants may relax stiff, contracted muscles. These drugs include diazepam (Diazepam Intensol, Valium), tizanidine (Zanaflex), dantrolene (Dantrium), and baclofen. There is some risk of dependency with diazepam, so it's not recommended for long-term use. Its side effects include drowsiness, weakness and drooling. Side effects of tizanidine include sleepiness, weakness, low blood pressure and liver damage. Side effects of dantrolene and baclofen include sleepiness. Baclofen may also be pumped directly into the spinal cord with a tube. The pump is surgically implanted under the skin of the abdomen.
A variety of nondrug therapies can help a person with cerebral palsy to enhance functional abilities. These include the following:
- Physical therapy. Muscle training and exercises may help your child's strength, flexibility, balance, motor development and mobility. Braces or splints may be recommended for your child. Some of these supports are used to help with function, such as improved walking. Others may stretch stiff muscles to help prevent contractures.
- Occupational therapy. Using alternative strategies and adaptive equipment, occupational therapists work to promote your child's independent participation in daily activities and routines in the home, the school and the community.
- Speech therapy. Speech therapists help improve your child's ability to speak clearly or to communicate using sign language. They can also teach your child to use special communication devices — such as a board covered with pictures of everyday items and activities. Sentences can be constructed by pointing to the pictures. Speech therapists may also address difficulties with muscles used in eating and swallowing.
Surgical or other procedures
Surgery may be needed to lessen muscle tightness or correct bone abnormalities caused by spasticity. These treatments include:
- Orthopedic surgery. Children with severe contractures or deformities may need surgery on bones or joints to place their arms and legs in their correct positions. Surgical procedures can also lengthen muscles and tendons that are proportionally too short because of severe contractures. These corrections can lessen pain, improve mobility, and make it easier to use a walker, braces or crutches.
- Severing nerves. In some severe cases, when other treatments haven't helped, surgeons may cut the nerves serving the spastic muscles. This relaxes the muscle and reduces pain, but can also cause numbness.
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- Information for Healthcare Professionals: OnabotulinumtoxinA (marketed as Botox/Botox Cosmetic), abobotulinumtoxinA (marketed as Dysport) and rimabotulinumtoxinB (marketed as Myobloc). U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm174949.htm. Accessed Sept. 30, 2010.
- Patterson MC (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 9, 2010.