Cerebral Palsy (cont.)
What are specific treatment plans for cerebral
palsy?
After the initial evaluation, specific treatment plans are outlined for each
child:
Seizure medication
If the child has seizures, the treatment is based on the
type and frequency of the seizures. Complete seizure control can often be
achieved using a single medication, but some children with cerebral palsy have particularly
difficult-to-control seizures. Medication can have side effects affecting the
brain, ranging from sedation to hyperactivity. They can also affect liver
function, white and red blood cells, and bone metabolism. Side effects are usually
not harmful and resolve when the offending medication is discontinued. The goal
of the treating physician should be for the child to become seizure free with
few or no side effects. It must be noted that it is of no benefit to the child
to be seizure-free but significantly impaired by medication side effects.
Medications for spasticity: The treatment of spasticity can involve multiple
health professionals. Treatments involve the use of medications and surgical
procedures to decrease the spasticity, facilitate movement, and prevent
contractions. Among the most commonly medications are
dantrolene sodium
(Dantrium) and diazepam (Valium). Diazepam is both a muscle relaxant and a
sedative. Baclofen (Lioresal)
can be taken by mouth or infused continuously with an
implanted pump (intrathecal infusion) directly in the cerebrospinal fluid (the
liquid that bathe the spinal cord and the brain). This treatment might be
specifically useful for patients with spasticity in the lower legs. The most
common complications with these medications are drowsiness, sleepiness, some
degree of weakness. The sedative side effects of such medications often limit
their usefulness. In the case of the baclofen pump the most common complication
seen in small number of patients is the infection of the catheter. Additionally,
a muscle relaxing agent called botulinum toxin can be injected into tight
muscles to relax them. When used prudently, this procedure may prevent surgical
intervention.
Surgery
Surgery for spasticity: In the case of severe muscle spasticity, surgery may
be a valuable option. Tendon release procedures, usually performed by an
orthopedic surgeon, allow improved range of motion in some cases. Such
procedures are usually performed on the muscles of the calf or inner thigh. A
less commonly used procedure, is the dorsal rhizotomy. During this operation,
the surgeon cuts some of the nerve roots that send sensory information from the
muscles to the spinal cord and brain. This procedure relieves some of the
spasticity and thereby helps the child walk with a more normal gait. Most
neurosurgeons performing dorsal rhizotomies very carefully select only those
patients whom they feel may be helped by the surgery. From time to time, other
surgical interventions are required in children with cerebral palsy. In very rare cases of
choreoathetoid cerebral palsy, in which the writhing movements severely limit the ability of
the child to function, highly selective neurosurgical techniques can curtail
these movements without significantly harming other functions.
Other surgical procedures
Ophthalmologists (eye specialists) can help strabismus by operating on the
muscles that control the movement of the eye or to correct some other
complications such as cataracts.
Neurosurgeons can treat intractable seizure control. Operations such as
callosotomy, hemispherectomy, focal resections of areas of abnormal brain tissue
responsible for the seizures, might be indicated in some cases. An alternative
procedure for the treatment of epilepsy is the vagal nerve stimulation, an
implantable device, that can be useful in selected patients with difficult to
control seizures.
Scoliosis, or curvature of the spine, is often the result of severe
hypotonia. This condition can create discomfort for the patient and difficulty
for caregivers in performing the activities of daily living. Furthermore, severe
scoliosis may actually restrict a patient's ability to breathe. Several surgical
procedures are available in specialized centers for the correction of scoliosis.
Children who are unable to take adequate calories by mouth may require the
placement of a feeding gastrostomy tube (PEG tubes) directly into the stomach.
Therapy
The treatment of spasticity can involve multiple allied healthcare professionals.
Physical and occupational therapists play an important role.
Physical therapy: The extent of physical therapy depends on the degree of
spasticity, hypotonia, and motor impairment. The main therapeutic effect of
physical therapy is maintaining range of motion at the joints, thereby
preventing contractures. Some scientists and therapists feel that physical
therapy actually helps maintain the connections in the brain, although this is
controversial. Other skills, such as improved gait, stance, and balance can be
helped by physical therapy. A strong, proactive physical therapy program greatly
aids in the life of a child with cerebral palsy.
Occupational therapy: Occupational therapy assists children with the skills
needed for day-to-day life in school and at home, including eating, writing, and
work skills. In early infancy, occupational therapists can provide assistance in
feeding a child with a poor or uncoordinated sucking response.
Speech therapy: Speech and language pathologists are involved with the
development and improvement of speech production. Using different techniques the
speech pathologist helps to improve the quality and the quantity of the speech
production. The role of these specialists is not limited to speech production
alone, but they also teach the patients other communication techniques (sign
language, use of communication boards) to facilitate the communication
abilities.
Medical care
Medical care of children with cerebral palsy is often seriously hampered by
the inability of the child to communicate his or her needs and sensations.
Relatively common childhood illnesses in children with cerebral palsy, such as ear
infections, urinary tract infections, and appendicitis, which are easily
treatable in most children, may prove to be life-threatening due to delayed
recognition on the part of caregivers and physicians. Each child with cerebral
palsy should
have a primary care practitioner that is experienced with the special medical
needs of affected children.
Because physicians have offered limited hope in curing cerebral palsy, many families have
turned to alternative methods in the treatment of their children. Such therapies
may include diets, herbal remedies, aromas, play with animals, and hyperbaric
oxygen. The scientific evidence supporting the use of diets is inadequate.
Some of them such as hyperbaric oxygen therapy, which is delivered in
specialized centers, can be quite expensive and has not been scientifically
proven to help children with cerebral palsy. Other remedies must be investigated on a
case-by-case basis. Hopefully, the family of the affected child will be able to
approach their physician regarding these alternative treatments.
Next: What is the long-term outlook for patients with cerebral
palsy? »
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