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© 2010 American Academy of Neurology Special Article 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 SocietyFrom the University of Texas Southwestern Medical Center (M.R.D.), Dallas; National Institute of Neurological Disorders and Stroke (D.H.), Bethesda, MD; United Cerebral Palsy Research Foundation (M.A.); Loma Linda University (S.A.), Loma Linda, CA; Bloorview Kids Rehab (D.L.F.), Toronto, Canada; University of Washington (J.M.), Seattle; University of New Mexico (L.A.M.), Albuquerque; The Core Institute (M.W.S.), Sun City West, AZ; Louisiana State University (A.T.), New Orleans; and Cincinnati Children's Hospital (J.V.-A.), Cincinnati, OH. Address correspondence and reprint requests to American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116 guidelines{at}aan.com 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. Recommendations: 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).
Abbreviations: AAN = American Academy of Neurology; AE = adverse event; AS = Ashworth scale; BoNT-A = botulinum toxin type A; BoNT-B = botulinum toxin type B; CP = cerebral palsy; FDA = Food and Drug Administration; GAS = Goal Attainment Scale; GMFM = Gross Motor Function Measure; ITB = intrathecal baclofen; MAS = Modified Ashworth scale; OT = occupational therapy; PT = physiotherapy; QUEST = Quality of Upper Extremity Skills Test; TS = Tardieu scale.
Supplemental data at www.neurology.org Appendices e-1 through e-4, tables e-1 through e-3, and references e1 through e19 are available on the Neurology® Web site at www.neurology.org. Approved by the Quality Standards Subcommittee on February 7, 2009; by the AAN Practice Committee on April 10, 2009; by the CNS Practice Committee on December 7, 2009; by the AAN Board of Directors on October 19, 2009; and by the CNS Board of Directors on December 11, 2009. Disclosure: Author disclosures are provided at the end of the article. Received April 23, 2009. Accepted in final form October 9, 2009. This article has been cited by other articles:
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