Medication and Drug Therapy

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A wide assortment of medications is utilized to treat Cerebral Palsy. Some reduce
symptoms, while others address complications. Drug therapy is used to control
body movements, prevent seizures, treat depression, relax muscles, assist
digestion, and manage pain. Medication is often adjusted for tolerance and
effectiveness.

What medications are used to treat Cerebral Palsy?

A wide assortment of medications for Cerebral Palsy is used to reduce symptoms and
address complications. Children who experience seizures, spasticity, and unwanted or
uncontrolled movements, such as athetosis and chorea, for example, are often
prescribed drugs to minimize the movements. Some medications are used to relax
muscles, increase comfort and facilitate better posture.
Medication is often prescribed to improve associated conditions, as well. Many drugs
will aid digestive problems, breathing difficulties, skin conditions, and behavioral or
learning issues.
When choosing prescriptions, doctors and parents consider the benefits as well as the
short- and long-term side effects. Many drugs used to treat Cerebral Palsy are very
powerful, and some are not recommended for children. Some doctors may avoid
prescribing certain medications to children because of the potential impact on the childs
growth and development.
Drug manufacturers change, new medications are developed, industry regulations
fluctuate and insurance coverage is modified annually.
Despite extensive knowledge of the medical field and pharmaceutical industry, it is often
a process of trial and error for a doctor to determine which drug will work best and in

what dosage for any given child. Even when success is achieved, some medications
must be regularly monitored and adjusted.
Certain medications are designed to target specific conditions, such as seizures, but
that medication may be available in several different forms. Since every person has his
or her own unique chemistry, a medication that works well for one child may have
adverse effects on another. Some children may acquire tolerance of some medications
and require an adjustment in dosage.
All changes in conditions, symptoms or treatment should be shared with the primary
care physician to ensure drug therapy is properly prescribed.
The most common medications used to treat Cerebral Palsy include medications within
these categories:

Anticholinergics (uncontrolled body movements)

Anticonvulsants (seizure medications)
Antidepressants (depression medications)
Antispastic (muscle relaxers)
Anti-inflammatories (pain management)
Stool softeners

These categories are detailed below.

Anticholinergics (uncontrolled body movements)

Anticholinergic medications are used to treat uncontrolled body movements such as
muscle stiffness, tremors and spasms, as well as drooling associated with non-spastic
Cerebral Palsy. The result of the medication is temporary. In large doses, some
anticholinergics can stimulate the nervous system; in small doses the drug can act as a
depressant.
Common uses include treating spastic conditions in the digestive tract, reducing saliva,
and decreasing bronchial secretions. Some forms of Cerebral Palsy where
anticholinergics may also be prescribed include:

Athetosis slow, writhing movements that are often repetitive and

involuntary

Chorea jerky, involuntary, irregular and uncontrollable movements

Choreoathetoid a combination of chorea and athetosis, where
movements are jerky, twitching, slow and writhing
Dystonia prolonged, involuntary contractions that result in twisting
motions, tremors and abnormal posture

These drugs work by blocking the neurotransmitter that causes muscles to move.
Excessive movement is often caused by excessive flexing of muscles. Nerve impulses
cause acetylcholine to be produced and travel across the gaps between nerves. When it
binds to the second nerve, it fires, eventually stimulating the prospective muscle.
Anticholinergics prevent the acetylcholine from binding to the second nerve, thus
limiting muscle stimulation.
Anticholinergic side effects are typically mild, and can include dry mouth, blurred vision,
and constipation. To avoid amplification of side effects, this drug is not usually
prescribed along with antihistamines commonly used to treat allergies.
Common anticholinergic medications are:

Benztropine mesylate
Carbidopa-levodopa (Sinemet)
Glycopyrrolate (Robinul)
Procyclidine hydrochloride (Kemadrin)
Trihexyphenidyl hydrochloride

Anticonvulsants (seizure medications)

Anticonvulsants are prescribed in hopes of reducing or preventing seizure activity. They
also stabilize mood. Anticonvulsants reduce, or depress, excessive stimulation to the
brain without affecting respiration or causing drowsiness. Different drugs control
different types of seizures. To prescribe properly, the medical provider selects a type
and dosage appropriate to the specific type of seizure the child is experiencing. The
child is then monitored closely for any adverse reactions, which may result in a
prescription or dosage change.
Prescriptions should be followed as prescribed so medications can be properly
monitored and adjusted. Parents are urged to keep a journal of episodes and reactions
for practitioner review.

Prescribed medicines may be changed or dosages altered based on the childs

reactions, or over time as the childs body will likely build tolerance to the medication. A
childs dosage may be higher than what is required for an adult, as children process the
drug faster. Individuals are known to respond to anticonvulsants differently.
Anticonvulsant dosage can be increased, but at a certain point it becomes advisable to
switch medications an event known as a changeover altogether. If a changeover
does occur, the child is weened from the previous medication to minimize or alleviate
withdrawals. Withdrawals can cause anxiety, cramping, delirium, hallucinations, temper
tantrums, trembling, and even death.
In some instances, practitioners will prescribe multiple drug therapy by combining more
than one anticonvulsant. This increases the risk of adverse side effects, drug
interactions, and complicates the ability to analyze the reaction to the prescriptions.
Side effects from anticonvulsants can vary depending on the drug prescribed, but may
include constipation, convulsions, dizziness, drowsiness, fatigue, hair loss, headaches,
incontinence, and nausea. Anticonvulsants may also cause a change in appetite, mood,
weight, and vision.
Common anticonvulsants include:

Gabapentin (Neurontin)
Lamotrigine (Lamictal)
Oxcarbazepine (Trileptal)
Topiramate (Topamax)
Zonisamide (Zonegran)

Antidepressants (depression medications)

Antidepressants are psychiatric medications with mood altering and analgesic qualities
used to treat depression, anxiety, and in some cases seizures. One-third of those with a
chronic illness, such as Cerebral Palsy, may be depressed. Depression is a persistent
sense of sadness, helplessness, and hopelessness.
The following factors inherent in impairment may contribute to an individuals
depression:

Perceived limitations
Chronic pain levels
Perceived stigmas of those with disability
Lack of control and coordination
Dependence upon others
Feelings of powerlessness
Peer pressure
Social isolation
Quality of life

In addition, depression can worsen the medical condition by:

Aggravating the Cerebral Palsy

Decreasing confidence
Increasing fatigue
Intensifying pain
Worsening ability to cope

Not only are the individuals with chronic medical conditions at risk, but those who are
caring for them are also susceptible to depression due to:

the stress of caring for an individual with a chronic medical condition

the challenges of day-to-day living with added responsibilities
feelings of helplessness and hopelessness in not being able to cure the

individual
the emotional toll of a childs diagnosis and the life-long realities of the

condition
the financial burden of disability
sense of being overwhelmed

With depression comes loss of appetite, concentration, energy, interest, sleep, and
pleasure. Other signs of depression may involve:

Fatigue
Indecisiveness
Irritability
Isolation
Lethargy
Moodiness

Personality change
Pessimism
Testiness
Suicidal tendencies or thoughts
Whining

Surprisingly, research indicates a person is more prone to depression from lack of

coping skills and perspective, rather than the actual severity of a medical condition.
Some have reported the stigma associated with depression keeps individuals from
seeking help. However, depression is highly treatable.
Treatment for depression is multi-faceted. Focus is on gaining emotional support,
guidance, counseling, and perspective. Drug therapy can be used exclusively or in
combination with any of the following:

Behavioral therapy to identify and address perception and gain new

perspective
Biofeedback and massage therapy to relax, meditate, calm, peacefully

escape, and energize

Healthy diet and exercise to provide the body with essentials to cope
Sleep to rest properly and re-energize
Support groups for emotional support and to relate to others in similar

state
Psychotherapy for professional assistance to optimize mental health

The benefits of treatment for depression can be life-altering. Drug therapy changes the
brain chemistry in a way that can be euphoric, provide hope, increase energy levels,
supply optimism, enhance therapy participation, and provide the ability to cope with
everyday life. A person who forgoes treatment for depression runs the risk of magnifying
symptoms, and in some instances, developing suicidal tendencies. A person with
depression may not always recognize or acknowledge their condition.
Antidepressants, in combination with other medicines, may result in serious side effects
and death. The primary medical provider should be aware of all the prescriptions,
treatments and health conditions to thwart drug interactions, harmful side effects, or
dangers. Antidepressants can also be harmful during pregnancy. If pregnancy is
suspected, a doctor should be consulted immediately.

Side effects from antidepressants may include:

Agitation
Blurred vision
Constipation
Dizziness
Dry mouth
Headache
Insomnia
Nausea
Nervousness
Stomach upset
Weight gain

Some commonly prescribed antidepressants include:

Citalopram Celexa
Escitalopram Lexapro
Fluoxetine Prozac
Paroxetine Paxil
Sertraline Zoloff

Antispastic (muscle relaxers)

Antispastics, also known as muscles relaxers, are prescribed to relax contracted,
overactive, or stiff muscles. Antispastic medications are often the first treatment choice
for reducing tremors or controlling widespread spasticity, as they are easy to use and
non-invasive.
Antispastics can be administered orally in tablet form, or by injection directly into
affected muscles or via the intrathecal baclofen pump, which is surgically implanted in
the abdomen to deliver medication directly to the fluid that surrounds the spinal cord.
Oral medications are usually prescribed for overall spasticity, while injections target a
specific muscle. The benefits of oral medications and injections are usually short-term,
requiring refills or further injections. The pump, on the other hand, provides steady
doses of medication on a long-term basis. The pump must be maintained and refilled so
as not to run the risk of abrupt withdrawals, or death.

The specific antispastic medication prescribed, as well as dosage, length of treatment,

method of administration and the use of other complementary treatments, vary with
each individual and his or her circumstance. For example, oral medications, such as
valium, are typically administered daily. Alcohol wash injections target specific nerves
and can provide relief for a few months to several years. Botox is usually administered
in three-month intervals. Other injectable antispasmodics typically remain effective for
about three to eight months. The intrathecal baclofen pump is found to be most effective
on those with chronic, severe stiffness and those with uncontrolled muscle movements.
Some benefits derived from antispastic medications include:

Control muscle contractions

Delay surgery
Increase range of motion
Improve ability to participate in therapies
Reduce impairment
Reduce tremors and muscle spasms
Relax overactive muscles
Relax tight muscles

Possible side effects to antispastic medications, vary with the type, the individual, and
the dosage, but may include:

Confusion
Constipation
Diarrhea
Dizziness
Drowsiness
Flu-like symptoms
General weakness
Headache
High blood pressure
Incontinence
Insomnia
Liver damage
Nausea

Pain upon injection

Slowed heart rate
Slurred speech

Medications vary in the way they relax muscles. Some, like baclofen, relax the muscle
directly, while others, like diazepam, act on brain chemistry. Botox(R) causes mild
muscle paralysis. Commonly prescribed antispastic medications include:

Baclofen (Botulinum toxin, or Botox(R))

Diazepam (Valium(R))
Dantrolene
Flexeril (Cyclobenzadrine)
Dantrium (Dantrolene)
Intrathecal Baclofen
Tizanidine

Anti-inflammatories (pain control)

Medscape reports 67%-84% of individuals with Cerebral Palsy experience bothersome
pain lasting one hour or longer per episode. Anti-inflamatories address pain by reducing
or alleviating inflammation.
Many medications and alternative treatments are available to manage pain often
associated with Cerebral Palsy. Pain medications can range from over-the-counter
(OTC) to prescription drugs, such as non-steroidal, anti-inflammatory drugs (NSAIDs) or
anti-inflammatory corticosteroids. Many of these medications play a significant role in
reducing pain as they alleviate the primary causes of discomfort. For minor pain,
alternative therapies hot or cold compresses, acupuncture, or massage therapy, for
example may be considered.
Pain can result from the actual health conditions involved with Cerebral Palsy, or can be
experienced when exercising, strengthening and expanding range-of-motion during
physical therapy. Pain also results from surgery and post-operative healing, or even
from medications injected or administered through a pump. Adjusting to and using
orthotics can cause painful sores, while adaptive equipment can cause discomfort from
pressure and continual use. Treatment of these, and other sources of pain, can increase
overall health.

Some common origins of pain in those with Cerebral Palsy, include:

Gastrointestinal pain abdominal pain related to digestive complications

from malnutrition, malabsorption, impaired orofacial functioning, esophageal

issues, aspiration, incontinence, constipation and flatulence.
Orthopedic pain deformity, compensation, subluxation, degeneration, and

dislocation found in the face, fingers, hands, arms, shoulders, back, spine,
hips, pelvis, legs, ankles, feet or toes. Procedures performed on the bones,
ligaments, joints, tendons, muscles, and nerves. Orthotic overuse, underuse,
skin irritation, and rubbing can cause pain, as well.
Pharmaceutical interventions needle injections, including blood draws,

pain medication, intravenous therapy, nasogastric tube placement, and

anesthesia.
Rehabilitative therapies pain worsened by therapy sessions involving

assisted stretching and range of motion exercises, including occupational,

physical, speech and language therapy.
Surgical pain pain derived from surgical procedure, post-operative
healing, and needle injections such as blood draws, pain medication, and
intravenous feeds.

Pain medication can be helpful in reducing or alleviating pain. Not all pain medication
can be taken by children or women who may be pregnant. All medications should be
cleared by the primary care physician who will ensure there are no adverse effects, can
monitor the effectiveness, can check for drug interactions, and is knowledgeable in
properly prescribing the drug and its assigned dosage. Four main categories of antiinflammatories include:

Aspirin suppresses prostaglandins, regulates body temperature, and

constricts blood.
Corticosteroids anti-inflammatory agent with a large number of other

functions, such as glucose utilization, fat metabolism, and bone

development.
Nonsteroidal anti-inflammatory drugs (NSAIDs) a non-steroid substance

which has analgesic, antipyretic, and platelet-producing capabilities to

primarily treat mild to moderate pain, and fever.
Steroids decrease inflammation and reduce immune system activity.

Stool softeners
Constipation, a dry, hard stool that is difficult and possibly painful to pass, is common in
children with Cerebral Palsy. The condition can be caused by medications, lack of
activity, inadequate fluid intake, dietary complications, difficulty in accessing bathrooms
and labored breathing.
The primary way to treat constipation is with a healthy diet rich in high-fiber foods.
Laxatives, which can be very useful, come in several forms. Stool softeners help to
maintain water content to prevent stool from becoming hard and painful. Various
stimulants induce bowel contractions and move stool along the intestinal tract.

For more information

To learn about pain management and Cerebral Palsy, visit Pain Management.
To verify that medication has been approved by the Food and Drug Administration,
visit FDA Approved Medications.
http://www.cerebralpalsy.org/about-cerebral-palsy/treatment/medication
19.11.2016