Pharmacological management of abnormal tone and movement in cerebral palsy

Daniel E. Lumsden*, Belinda Crowe, Anna Basu, Sam Amin, Anita Devlin, Yasmin Dealwis, Ram Kumar, Rajib Lodh, Claire T. Lundy, Santosh R. Mordekar, Martin Smith, Jill Cadwgan

*Corresponding author for this work

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Abstract

Background The evidence base to guide the pharmacological management of tone and abnormal movements in cerebral palsy (CP) is limited, as is an understanding of routine clinical practice in the UK. We aimed to establish details of motor phenotype and current pharmacological management of a representative cohort across a network of UK tertiary centres. Methods Prospective multicentre review of specialist motor disorder clinics at nine UK centres, collecting data on clinical features and pharmacological management of children and young people (CYP) with CP over a single calendar month. Results Data were collected from 275 CYP with CP reviewed over the calendar month of October 2017. Isolated dystonia or spasticity was infrequently seen, with a mixed picture of dystonia and spasticity ± choreoathetosis identified in 194/275 (70.5%) of CYP. A comorbid diagnosis of epilepsy was present in 103/275 (37.4%). The most commonly used medications for abnormal tone/movement were baclofen, trihexyphenidyl, gabapentin, diazepam and clonidine. Medication use appeared to be influenced separately by the presence of dystonia or spasticity. Botulinum toxin use was common (62.2%). A smaller proportion of children (12.4%) had undergone a previous neurosurgical procedure for tone/movement management. Conclusions CYP with CP frequently present with a complex movement phenotype and comorbid epilepsy. They have multiple therapy, medical and surgical management regimens. Future trials of therapeutic, pharmacological or surgical interventions in this population must adequately encompass this complexity in order to be translatable to clinical practice.

Original languageEnglish
Pages (from-to)775-780
Number of pages6
JournalArchives of Disease in Childhood
Volume104
Issue number8
Early online date19 Jul 2019
DOIs
Publication statusPublished - 1 Aug 2019

Keywords

  • neurodisability
  • neurology
  • pharmacology

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    Lumsden, D. E., Crowe, B., Basu, A., Amin, S., Devlin, A., Dealwis, Y., Kumar, R., Lodh, R., Lundy, C. T., Mordekar, S. R., Smith, M., & Cadwgan, J. (2019). Pharmacological management of abnormal tone and movement in cerebral palsy. Archives of Disease in Childhood, 104(8), 775-780. https://doi.org/10.1136/archdischild-2018-316309