page_title: Management of cerebral palsy
section_title: Medication
hierarchical_section_title: Management of cerebral palsy / Medication
caption_attribution_description: English: 3d ribbon model of botulinum neurotoxin serotype A (botox) from PDB 3BTA. Ref.: Lacy, D.B., Tepp, W., Cohen, A.C., DasGupta, B.R., Stevens, R.C. (1998) Crystal structure of botulinum neurotoxin type A and implications for toxicity. Nat.Struct.Biol. 5: 898-902 PMID 9783750
context_page_description: Over time, the approach to cerebral palsy management has shifted away from narrow attempts to fix individual physical problems – such as spasticity in a particular limb – to making such treatments part of a larger goal of maximizing the person's independence and community engagement. Much of childhood therapy is aimed at improving gait and walking. Approximately 60% of people with CP are able to walk independently or with aids at adulthood. However, the evidence base for the effectiveness of intervention programs reflecting the philosophy of independence has not yet caught up: effective interventions for body structures and functions have a strong evidence base, but evidence is lacking for effective interventions targeted toward participation, environment, or personal factors. There is also no good evidence to show that an intervention that is effective at the body-specific level will result in an improvement at the activity level, or vice versa. Although such cross-over benefit might happen, not enough high-quality studies have been done to demonstrate it.
context_section_description: Several kinds of medication have been used to treat the various kinds of cerebral palsy.
  Adults with CP are more likely to use medication to manage pain than active pain management methods.
  Botulinum toxin injections are given into muscles that are spastic or sometimes dystonic, the aim being to reduce the muscle hypertonus that can be painful. A reduction in muscle tone can also facilitate bracing and the use of orthotics. Most often lower extremity muscles are injected. Botulinum toxin is focal treatment, meaning that a limited number of muscles can be injected at the same time. The effect of the toxin is reversible and a reinjection is needed every 4–6 months.  In children it decreases spasticity and improve range of motion and thus has become commonly used.  Botulin toxin has been used in CP treatment for around two decades and can be recommended for children above the age of two.  A Cochrane review published in 2010 found that there is high level evidence in the use of botulinum toxin as an add on therapy to occupational therapy in order to manage spasticity in the arms of children with cerebral palsy. However, there is no strong research associated with the use of botulinum toxin in the management of spasticity in the legs or improving gait compared to casting. More evidence related to the frequency and dosage of injections as it relates to long-term outcomes is needed in order to support or refute the use of botulinum toxin in the management of lower limb spasticity in children with cerebral palsy.
  Dosages of botulin toxin have been based on expert opinion rather than evidence-based practices.  The dosages recommended have recently been reduced to reduce severe side-effects including becoming sensitive to the botulin toxin and developing an allergic response.  Higher risks have been noted with children who are at level IV and V on the GMFCS.  A review on the treatment of drooling in children with cerebral palsy found that it was not possible to tell whether interventions worked or were safe, including botulin toxin A and benztropine and glycopyrrolate.
  Bisphosphonates are used to treat osteoporosis in adults.  Osteoporosis is common in children with cerebral palsy, and non-oral bisphosphonates have been used to treat children with a very low bone mass density and a medical history of fragility fracture.
  A 2018 Cochrane review (one study met inclusion criteria) on the use of Trihexyphenidyl for dystonia found insufficient evidence of its effectiveness.
  Anticholinergics may be used to reduce drooling, but may contribute to constipation.
  Oral baclofen or diazepam is used to reduce spasticity which results in pain, muscle spasms or functional disability.  Baclofen is used for a long-term effect and works at the spinal level.  Diazepam is fast-acting.
  Sometimes, medication used to manage physical aspects of CP can have effects on the person's mental health, or medications used to manage mental health can affect motor function.
caption: Botulinum toxin
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