Cerebral
Palsy & Spasticity -
Treatments
BOTOX® The goal of this cerebral palsy intervention is to
increase a person's
function by decreasing rigidity and spasms while improving range of motion.
One method that has consistently produced positive results is the injection
of Botulinum toxin, or BOTOX®.
BOTOX® is injected directly into the spastic muscle with the person receiving
a dose according to body weight. A small needle is used to administer the
BOTOX® and there is only minor discomfort associated with the brief
treatment. BOTOX® can be given without anesthesia and few complications have
been reported from it other than the fact it can cause localized
weakness,
which is actually its desired response. Also, about 10
percent of
individuals can develop antibodies to BOTOX® if given repetitive injections
over several years, negating its
effect.
Results are typically not seen from BOTOX®
injections for five to seven days with a peak effect at two weeks. Range of motion exercises and other
spasticity -reducing techniques can be used immediately following injection.
This form of treatment generally lasts about 12 weeks, then another dose can
be administered. If enough tissue lengthening has
occurred through stretching and splinting, a permanent effect of increased range of motion
can be realized.
Frequently
Asked Questions
.
BACLOFEN PUMP
One of the most significant advances in the treatment of cerebral palsy has
been the introduction of the Baclofen pump, a device that is surgically
implanted into the lower abdomen of a patient to deliver a medication called
Baclofen directly into the spinal cord.
The spinal cord is typically where the release
of a chemical called Gamma amino butyric acid (GABA) occurs, signaling the leg and lower back muscles
to relax. In people with cerebral palsy, spasticity occurs because of the
nervous system's inability to release GABA. When Baclofen is introduced into
the spinal cord, it functions the same way as GABA, thereby reducing spasms
and blocking abnormal nerve signals so the patient can control his or her
muscles. The pump can be implanted in both adults and children.
Because the medication is delivered directly
to the spinal cord, it relieves spasticity with only a fraction of the dose required if taken orally, making
it much more efficient. In addition, many of the chronic side effects such
as drowsiness are greatly reduced.
The pump implant procedure lasts about an hour, after which the pump is
programmed to deliver the precise dose of Baclofen to the patient. Pumps are
refilled with additional medication approximately every three months. This
can be done right in the medical office by injecting a small needle through
numbed skin into the center of the pump.
It is possible to remove the pump should outcomes not be desirable.
Miller-Dwan is one of a growing number of clinical sites nationwide to offer
this innovative approach for managing spasticity in individuals with
cerebral palsy. Miller-Dwan was also part of the original Baclofen pump FDA
study protocol.
Frequently
Asked Questions
.
SELECTIVE POSTERIOR RHIZOTOMY
Selective posterior rhizotomy is a
neurosurgical technique that is also used
to manage spasticity, especially in children. In
this procedure, neurosurgeons expose nerves in the spinal canal which go to and from the
muscles in the legs and cut from 30 to 50 percent off the top half of each
nerve. This usually results in relief from spasticity, and is a permanent,
irreversible procedure.
Candidates for this procedure are young
children (older than age 4) who still have good leg strength and do not have severe leg contractures. The
operation is followed by intense physical therapy for up to a year and often
results in improved walking skills due to a loosening of
tightened legs. It
is not a procedure offered to adults.
Frequently
Asked Questions
BOTOX®
is a registered trademark of Allergan,
Inc.
.
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