Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society.
OBJECTIVE
To evaluate published evidence of efficacy and safety of pharmacologic treatments for childhood spasticity due to cerebral palsy.


METHODS
A multidisciplinary panel systematically reviewed relevant literature from 1966 to July 2008.


RESULTS
For localized/segmental spasticity, botulinum toxin type A is established as an effective treatment to reduce spasticity in the upper and lower extremities. There is conflicting evidence regarding functional improvement. Botulinum toxin type A was found to be generally safe in children with cerebral palsy; however, the Food and Drug Administration is presently investigating isolated cases of generalized weakness resulting in poor outcomes. No studies that met criteria are available on the use of phenol, alcohol, or botulinum toxin type B injections. For generalized spasticity, diazepam is probably effective in reducing spasticity, but there are insufficient data on its effect on motor function and its side-effect profile. Tizanidine is possibly effective, but there are insufficient data on its effect on function and its side-effect profile. There were insufficient data on the use of dantrolene, oral baclofen, and intrathecal baclofen, and toxicity was frequently reported.


CONCLUSIONS
For localized/segmental spasticity that warrants treatment, botulinum toxin type A should be offered as an effective and generally safe treatment (Level A). There are insufficient data to support or refute the use of phenol, alcohol, or botulinum toxin type B (Level U). For generalized spasticity that warrants treatment, diazepam should be considered for short-term treatment, with caution regarding toxicity (Level B), and tizanidine may be considered (Level C). There are insufficient data to support or refute use of dantrolene, oral baclofen, or continuous intrathecal baclofen (Level U).
University of Texas Southwestern Medical Center, Dallas, USA.
Delgado
M R
MR
Hirtz
D
D
Aisen
M
M
Ashwal
S
S
Fehlings
D L
DL
McLaughlin
J
J
Morrison
L A
LA
Shrader
M W
MW
Tilton
A
A
Vargus-Adams
J
J
D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000188:drug therapy*; D002648:Child; D003000:Clonidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003975:Diazepam / Q000627:therapeutic use*; D006801:Humans; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D009128:Muscle Spasticity / Q000188:drug therapy; D009465:Neuromuscular Agents / Q000627:therapeutic use; D016896:Treatment Outcome
D009125:Muscle Relaxants, Central; D009465:Neuromuscular Agents; C023754:tizanidine; D019274:Botulinum Toxins, Type A; D003000:Clonidine; D003975:Diazepam