Medical Management of Spasticity in Children with Cerebral Palsy

Abstract

Spasticity is the most common motor disorder in cerebral palsy (CP). It is a component of the upper motor neuron syndrome. Spasticity is probably due to an imbalance between inhibitory and excitatory impulses in the spinal cord. In CP, there is believed to be a deficiency of descending impulses that typically stimulate the release of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). Although some spasticity may be necessary for function in children with neurologic impairment, it is often a problem that can be difficult to treat. Multiple approaches are available for treatment of spasticity in patients with CP including therapies, oral medications, chemodenervation, and intrathecal baclofen therapy. Orthopedic and neurosurgical procedures are also available. A multidisciplinary team should be involved in defining reasonable treatment goals including the patient, and family, physical and occupational therapists, nurses, physiatrist, neurologist, orthopedist, and neurosurgeon.