Treatment of conditions with drugs. Long-term effects are not necessarily known. Many conditions associated with cerebral palsy are treated with drugs: those below are the major ones.
Chemodenervation using muscle relaxants
Medicines that act on the central nervous system. To relieve spasms, cramping and tightness of muscles, in cerebral palsy and other conditions of the brain and nervous system. They block the nerve impulses to muscles, relieving spasms and pain, and allowing other muscles to be developed through therapies. They may delay the need for surgery on contractures. They work by slowing down the release of acetylcholine, a neurotransmitter at the junctions of nerve and muscle cells.
Baclofen (Lioresal, ITB, Lyflex)
Given as a tablet, or administered intrathecally (by injection through the theca of the spinal cord into the subarachnoid space). Blocks signals sent from the spinal cord to contract the muscles. The intrathecal and pump methods are used in the hope of reducing side effects and fine-tuning the dosage. The pump, with a baclofen reservoir, is implanted under the skin of the abdomen, with a tube into the fluid chamber around the spinal cord. Long-term effects not yet established.
Botulinum toxin (Botox, Dysport)
Given by injection into the muscle, and eventually wears off.
Alcohol, Phenol, Dantrolene, and Eperisone hydrochloride E2000 tape (applied to the skin), have also been used as relaxants. Anectine is a muscle relaxant sometimes given in surgery.
Benzodiazepine tranquillizers
Mainly Diazepam ("Valium"), given to relieve anxiety as well as spasticity.
Drooling medication
Medication is sometimes given if other measures do not sufficiently control severe drooling. Drugs that have been tried include drying and antireflux medicines such as glycopyyrolate, ranitidine and cisapride.
Seizure control
A high proportion of children with cerebral palsy also have some form of seizures / epilepsy / fits (estimates vary between about 30% and 75%). In the population generally, according to the National Society for Epilepsy (NSE) the prevalence is about 1 in 200.
Seizure control can usually be achieved with medication (the NSE say, in about 70% of cases), but the epilepsy and medication picture changes with the age and condition of the child, so that the process is not the same as treating an adult. Knowledge about epilepsy medications and their use changes as well, and it is important to keep up to date, particularly for children under 12 years of age. The Internet needs to be treated with particular caution here, because many websites still contain information that has changed, and it is best to discuss with a child’s medical consultant, or for general information a specialist epilepsy organisation, for the latest information about these medications. As a first port of call the NSE produce a table of medication for children up to 12 years, http://tinyurl.com/2xxg7o; and a table for young people and adults aged 13 and over, http://tinyurl.com/2g6qvw.
Epilepsy Action, tel: 0808 800 5050, www.epilepsy.org.uk. In addition to the telephone service, twice weekly their helpline runs an online conversation you can ‘drop in’ on, to discuss epilepsy issues.
Epilepsy: The Information, tel: 020 7736 0123 produces literature directly for young people with epilepsy.
National Society for Epilepsy, tel: 01494 601400, www.epilepsynse.org.uk
The national organisations for epilepsy also carry information about a variety of other topics, for example: seizure alarm devices for night-time; identification cards and jewellery; medical centres for complex cases involving epilepsy; specialist schools; ketogenic diet for extreme cases; and seizures that are not caused by epilepsy (NOTE: not all seizures are.)
General information about medicines
Patient and practitioner leaflets on medicines, compiled by the pharmaceutical industry, www.emc.medicines.org.uk.
It is worth remembering that, as well as the prescribing doctors etc., pharmacists can answer questions about taking medicines. The Royal Pharmaceutical Society Library may also be able to answer enquiries from you or your pharmacist (there may be a small charge), tel: 020 7572 2300, and there is a large amount of information on their website, www.rpsgb.org.uk/informationresources.
Adverse reactions to therapeutic substances and devices
Both doctors and patients can use the Yellow Card Scheme to report suspected adverse reactions to the Medicines and Healthcare products Regulatory Agency (MHRA). They collect information from Yellow Cards about prescription medicines, herbal remedies, over-the-counter medicines and cosmetic products. They also regulate medical devices. They can then issue safety warnings on their website and in letters to health professionals, and recall products if necessary. Tel: 020 7084 2000,
www.mhra.gov.uk. The cards themselves can be obtained from pharmacies and GP surgeries, or tel: 0808 100 3352. (A known side-effect, as listed on the patient information leaflet that comes with the product, would not normally be classed as an adverse reaction.)
