Treatments and drugs

By Mayo Clinic Staff

Children and adults with cerebral palsy require long-term care with a medical care team. This team may include:

  • Pediatrician or physiatrist. A pediatrician oversees the treatment plan and medical care.
  • Pediatric neurologist. A doctor trained in diagnosing and treating children with brain and nervous system (neurological) disorders may be involved in your child's care.
  • Orthopedic surgeon. A doctor trained in treating muscle and bone disorders may be involved in diagnosing and treating muscle conditions.
  • Physical therapist. A physical therapist may help your child improve strength and walking skills, and stretch muscles.
  • Occupational therapist. An occupational therapist can provide therapy to your child to develop daily skills and to learn to use adaptive products that help with daily activities.
  • Speech-language pathologist. A doctor trained in diagnosing and treating speech and language disorders may work with your child if your child has difficulties with speech, swallowing or language.
  • Developmental therapist. A developmental therapist may provide therapy to help your child develop age-appropriate behaviors, social skills and interpersonal skills.
  • Mental health specialist. A mental health specialist, such as a psychologist or psychiatrist, may be involved in your child's care. He or she may help you and your child learn to cope with your child's disability.
  • Social worker. A social worker may be involved in assisting your family with finding services and planning for transitions in care.
  • Special education teacher. A special education teacher addresses learning disabilities, determines educational needs and identifies appropriate educational resources.

Medications

Medications that can lessen the tightness of muscles may be used to improve functional abilities, treat pain and manage complications related to spasticity or other cerebral palsy symptoms.

It's important to talk about the risk of drug treatments with your doctor and discuss whether medical treatment is appropriate for your child's needs. The selection of medications depends on whether the problem affects only certain muscles (isolated) or the whole body (generalized). Drug treatments may include the following:

  • Isolated spasticity. When spasticity is isolated to one muscle group, your doctor may recommend injections of onabotulinumtoxinA (Botox) directly into the muscle, nerve or both. Botox injections may help to improve drooling. Your child will need injections about every three months.

    Side effects may include pain, bruising or severe weakness. Other more-serious side effects include difficulty breathing and swallowing.

  • Generalized spasticity. If the whole body is affected, oral muscle relaxants may relax stiff, contracted muscles. These drugs include diazepam (Valium), dantrolene (Dantrium) and baclofen (Gablofen).

    There is some risk of dependency with diazepam, so it's not recommended for long-term use. Its side effects include drowsiness, weakness and drooling.

    Side effects of dantrolene include sleepiness, nausea and or diarrhea.

    Side effects of baclofen include sleepiness, confusion and nausea. Baclofen may also be pumped directly into the spinal cord with a tube. The pump is surgically implanted under the skin of the abdomen.

Your child also may be prescribed medications to reduce drooling. Medications such as trihexyphenidyl, scopolamine (Scopace) or glycopyrrolate (Robinul, Robinul Forte) may be helpful.

Therapies

A variety of nondrug therapies can help a person with cerebral palsy to enhance functional abilities. These include the following:

  • Physical therapy. Muscle training and exercises may help your child's strength, flexibility, balance, motor development and mobility. You will also learn how to safely care for your child's everyday needs at home, such as bathing and feeding your child.

    Braces or splints may be recommended for your child. Some of these supports are used to help with function, such as improved walking. Others may stretch stiff muscles to help prevent rigid muscles (contractures).

  • Occupational therapy. Using alternative strategies and adaptive equipment, occupational therapists work to promote your child's independent participation in daily activities and routines in the home, the school and the community.

    Adaptive equipment may include walkers, quadrupedal canes, seating systems or electric wheelchairs.

  • Speech and language therapy. Speech-language pathologists can help improve your child's ability to speak clearly or to communicate using sign language.

    Speech-language pathologists can also teach your child to use communication devices, such as a computer and voice synthesizer, if communication is difficult.

    Another communication device may be a board covered with pictures of items and activities your child may see in daily life. Sentences can be constructed by pointing to the pictures.

    Speech therapists may also address difficulties with muscles used in eating and swallowing.

  • Recreational therapy. Some children may benefit from recreational therapies, such as therapeutic horseback riding. This type of therapy can help improve your child's motor skills, speech and emotional well-being.

Surgical or other procedures

Surgery may be needed to lessen muscle tightness or correct bone abnormalities caused by spasticity. These treatments include:

  • Orthopedic surgery. Children with severe contractures or deformities may need surgery on bones or joints to place their arms, hips or legs in their correct positions.

    Surgical procedures can also lengthen muscles and tendons that are proportionally too short because of severe contractures. These corrections can lessen pain and improve mobility. These procedures may also make it easier to use a walker, braces or crutches.

  • Severing nerves. In some severe cases, when other treatments haven't helped, surgeons may cut the nerves serving the spastic muscles in a procedure called selective dorsal rhizotomy. This relaxes the muscle and reduces pain, but can also cause numbness.
Aug. 16, 2013