Pharmacologic interventions for management of spasticity in cerebral palsy

The management of the child or adult with spasticity associated with cerebral palsy may include a number of treatment techniques, including physical therapy, orthopedic surgery, neurosurgery, and pharmacologic management. The purpose of this review is to provide a framework in which the pharmacologic therapies for spasticity can be reviewed and to review common therapies using this outline. Many drugs are cited as having potential benefits, with diazepam, dantrolene, baclofen (oral and intrathecal), and botulinum toxin A receiving the most attention. Appropriate and effective use of these drugs is based on the patient\u27s condition, the child and family\u27s goals, an understanding of the principal mechanisms of pharmacologic action, potential side effects, short‐ and long‐term adverse outcomes and the efficacy of the agents. This review considers these drug treatments within the framework of the quality or strength of the evidence (based on study design), the generalizability of the patient population studied and the outcome measures used. Outcomes measures are classified according to the dimensions of pathophysiology, impairment, functional limitation, disability, and societal limitation, as per the National Center for Medical Rehabilitation Research model. Overall, the quality of evidence for pharmacologic management of children with spasticity of cerebral origin is relatively weak. Although randomized clinical trials provide the strongest efficacy evidence, they are still infrequent in the pediatric population. Outcome measures have focused primarily on the impairment domain, with very few studies measuring drug effects on functional limitation or disability. Despite these methodologic limitations, there is evidence that pharmacologic treatment has a role in the management of the pediatric patient with cerebral palsy