Transdermal clonidine patch use in the management of childhood hypertonia: a cross-sectional UK-wide service evaluation

Objectives:
Clonidine is increasingly used in the management of childhood motor disorders. Reports are limited regarding the use of transdermal clonidine patches (TCPs) for this indication. We aimed to explore the use of TCPs in children and young people (CAYP) across specialist movement disorder services in the UK.

Methods:
A cross-sectional service evaluation of TCP use in CAYP with motor disorders was performed. Where available, historical data on TCP use were also collected.

Results:
Data were available for 259 CAYP from 11 services, with 176/259 (68%) under active follow-up. Median age at starting TCPs was 8.6 years (25th to 75th centile 5.2–12 years). Gross Motor Function Classification System level (or equivalent) was V for 206/253 (81.4%) CAYP. Clinically significant chorea was observed in 33/255 (12.9%), spasticity in 116/254 (45.7%) and dystonia in 234/256 (91.4%) CAYP. The most common reasons for TCP initiation were overall dystonia severity (61/259, 23.6%), concerns about absorption of enteral medication (54/259, 20.8%) and excess sedation with enteral clonidine (46/259, 17.8%). TCP use had been discontinued by 61/259 (23.6%) CAYP, most commonly because of skin rash (24/259, 9.3%). The median time to discontinuing patches was 3.5 months. In addition to TCPs, 148/259 (57.1%) of CAYP continued with enteral clonidine. Additional tone-reducing medication use ranged from 0 to 6 additional medications (modal number of medications 3),

Conclusion:
We present the first UK-based multicentre evaluation of TCP use in CAYP with motor disorders, highlighting the complexity of the medical problems of these CAYP and their clinical management. TCPs appear generally to be tolerated by CAYP, but further work is required to establish their efficacy.