Review Article

Management of Muscle Spasms in Adult Patients with Cerebral Palsy

Authors: Samuel Korntner, Catherine Elko, Linda Edwards, MD, Rafik Jacob, MD

Abstract

As medical care advances, there is a growing number of adult patients with cerebral palsy. The spastic form is characterized by muscle hypertonicity, hyperreflexia, and spasticity, which are associated with worse quality of life, poor functionality, and pain. This literature review attempts to explore the existing treatments for spasticity in cerebral palsy to provide insight into potential treatments in the adult population. The types of treatments are broadly categorized into physical therapy, pharmacologic treatments, botulinum toxin, surgical treatments, and alternative options.

 
Posted in: Neurology17

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References

1. Marret S, Vanhulle C, Laquerriere A. Pathophysiology of cerebral palsy. Handb Clin Neurol 2013;111:169–176.
 
2. Andersen GL, Irgens LM, Haagaas I, et al. Cerebral palsy in Norway: prevalence, subtypes and severity. Eur J Paediatr Neurol 2008;12:4–13.
 
3. Himpens E, van den Broeck C, Oostra A, et al. Prevalence, type, distribution, and severity of cerebral palsy in relation to gestational age: a meta-analytic review. Dev Med Child Neurol 2008;50:334–340.
 
4. Blackman JA, Svensson CI, Marchand S. Pathophysiology of chronic pain in cerebral palsy: implications for pharmacological treatment and research. Dev Med Child Neurol 2018;60:861–865.
 
5. Pakula AT, Van Naarden Braun K, Yeargin-Allsopp M. Cerebral palsy: classification and epidemiology. Phys Med Rehabil Clin N Am 2009; 20:425–452.
 
6. Penner M, Xie WY, Binepal N, et al. Characteristics of pain in children and youth with cerebral palsy. Pediatrics 2013;132:e407–413.
 
7. Roscigno CI. Addressing spasticity-related pain in children with spastic cerebral palsy. J Neurosci Nurs J Am Assoc Neurosci Nurses 2002;34:123–133.
 
8. Flanigan M, Gaebler-Spira D, Kocherginsky M, et al. Spasticity and pain in adults with cerebral palsy. Dev Med Child Neurol 2020;62:379–385.
 
9. Jones KB, Wilson B, Weedon D, et al. Care of adults with intellectual and developmental disabilities: cerebral palsy. FP Essent 2015;439:26–30.
 
10. National Institute for Health and Care Excellence (UK). Spasticity in under 19s: management. https://www.ncbi.nlm.nih.gov/books/NBK554883/. Published 2016. Accessed August 11, 2020.
 
11. Dohin B. The spastic hip in children and adolescents. Orthop Traumatol Surg Res 2019;105(1S):S133–S141.
 
12. Hoffer MM, Garrett A, Koffman M, et al. New concepts in orthotics for cerebral palsy. Clin Orthop 1974;(102):100–107.
 
13. Novak I, Mcintyre S, Morgan C, et al. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol 2013;55:885–910.
 
14. MacIntosh A, Lam E, Vigneron V, et al. Biofeedback interventions for individuals with cerebral palsy: a systematic review. Disabil Rehabil 2019; 41:2369–2391.
 
15. Elshazly FA. Therapeutic functional electrical stimulation in hemiplegic cerebral palsy. Neurosci Riyadh Saudi Arab 2001;6:162–165.
 
16. Grecco LAC, Duarte N de AC, Mendonça ME, et al. Transcranial direct current stimulation during treadmill training in children with cerebral palsy: a randomized controlled double-blind clinical trial. Res Dev Disabil 2014;35:2840–2848.
 
17. Mathew A, Mathew MC, Thomas M, et al. The efficacy of diazepam in enhancing motor function in children with spastic cerebral palsy. J Trop Pediatr 2005;51:109–113.
 
18. McCormick ZL, Chu SK, Binler D, et al. Intrathecal versus oral baclofen: a matched cohort study of spasticity, pain, sleep, fatigue, and quality of life. PM R 2016;8:553–562.
 
19. Nemeth BA, Montero RJ, Halanski MA, et al. Epidural baclofen for the management of postoperative pain in children With cerebral palsy. J Pediatr Orthop 2015;35:571–575.
 
20. Harvey AR, Baker LB, Reddihough DS, et al. Trihexyphenidyl for dystonia in cerebral palsy. Cochrane Database Syst Rev 2018;5:CD012430.
 
21. Meholjić-Fetahović A. Treatment of the spasticity in children with cerebral palsy. Bosn J Basic Med Sci 2007;7:363–367.
 
22. O’Brien CF. Treatment of spasticity with botulinum toxin. Clin J Pain 2002; 18(6 suppl):S182–S190.
 
23. Jog M, Wein T, Bhogal M, et al. Real-world, long-term quality of life following therapeutic onabotulinumtoxinA treatment. Can J Neurol Sci 2016;43:687–696.
 
24. Calderón-González R, Calderón-Sepúlveda RF. [Treatment of spasticity in cerebral palsy with botulinum toxin]. Rev Neurol 2002;34:52–59.
 
25. Lundy CT, Doherty GM, Fairhurst CB. Botulinum toxin type A injections can be an effective treatment for pain in children with hip spasms and cerebral palsy. Dev Med Child Neurol 2009;51:705–710.
 
26. Wong C, Pedersen SA, Kristensen BB, et al. The effect of botulinum toxin A injections in the spine muscles for cerebral palsy scoliosis, examined in a prospective, randomized Triple-blinded study. Spine 2015;40:E1205–E1211.
 
27. Dauer WT, Burke RE, Greene P, et al. Current concepts on the clinical features, aetiology and management of idiopathic cervical dystonia. Brain J Neurol 1998;121(Pt 4):547–560.
 
28. Gelb DJ, Yoshimura DM, Olney RK, et al. Change in pattern of muscle activity following botulinum toxin injections for torticollis. Ann Neurol 1991; 29:370–376.
 
29. Chen J, Wang Y, Liu Y, et al. [Individualized neurosurgical treatments of spastic cerebral palsy]. Zhonghua Yi Xue Za Zhi 2014;94:376–378.
 
30. McLaughlin J, Bjornson K, Temkin N, et al. Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials. Dev Med Child Neurol 2002;44:17–25.
 
31. Xu J, Xu L, Zeng J, et al. [Clinical observation of selective posterior rhizotomy for improving spasticity and gross movement in patients with cerebral palsy]. Zhongguo Gu Shang China J Orthop Traumatol 2019;32:815–819.
 
32. Shao X, Yu Y, Zhang L, et al. [Complications of selective posterior rhizotomy for lower limb spasticity of cerebral palsy]. Beijing Da Xue Xue Bao 2015;47:160–164.
 
33. Rutz E, Baker R, Tirosh O, et al. Tibialis anterior tendon shortening in combination with Achilles tendon lengthening in spastic equinus in cerebral palsy. Gait Posture 2011;33:152–157.
 
34. Ruda R, Frost HM. Cerebral palsy. Spastic varus and forefoot adductus, treated by intramuscular posterior tibial tendon lengthening. Clin Orthop 1971;79:61–70.
 
35. Lin Y, Wang G, Wang B. Rehabilitation treatment of spastic cerebral palsy with radial extracorporeal shock wave therapy and rehabilitation therapy. Medicine (Baltimore) 2018;97:e13828.
 
36. Li L-X, Zhang M-M, Zhang Y, et al. Acupuncture for cerebral palsy: a metaanalysis of randomized controlled trials. Neural Regen Res 2018;13:1107–1117.
 
37. Zhang M, Liu Z. [Effects of acupuncture on muscle tension of lower limb in children with spastic cerebral palsy]. Zhongguo Zhen Jiu Chin Acupunct Moxibustion 2018;38:591–595.
 
38. Jin B, Zhao Y, Li N. [Impacts on adductor muscle tension in children of spasmodic cerebral palsy treated with acupuncture at the three-spasmneedle therapy]. Zhongguo Zhen Jiu Chin Acupunct Moxibustion 2015;35: 217–220.
 
39. Bhinde SM, Patel KS, Kori VK, et al. Management of spastic cerebral palsy through multiple Ayurveda treatment modalities. Ayu 2014;35:462–466.
 
40. Lucena-Antón D, Rosety-Rodríguez I, Moral-Munoz JA. Effects of a hippotherapy intervention on muscle spasticity in children with cerebral palsy: a randomized controlled trial. Complement Ther Clin Pract 2018; 31:188–192.
 
41. Strashko EY, Kapustianska АA, Bobyreva LE. Experience of using hippotherapy in complex effects on muscle spirals in children with spastic forms of cerebral palsy. Wiadomosci Lek Wars Pol 1960 2016;69(3 pt 2): 527–529.