Current Treatments for Cerebral Palsy

Yesterday I had a look through some papers to figure out what treatments are currently available for cerebral palsy. I found that there were a LOT of treatments, but unfortunately we still have a long way to go with regards to efficacy. Here's a list of treatments that have been used on patients with CP:

• Physiotherapy: focuses on gross motor skills, functional mobility, etc.
• Occupational therapy: daily skills like feeding, dressing, etc. Can enhance the outcomes following botulinum toxin injections, which I'll talk about later.
• Neurodevelopmental treatment (NDT): treatment that aims to normalise muscle tone and inhibit abnormal reflexes.
• Conductive education (CE): an educational and task-oriented approach given to groups of children.
• Therapeutic exercises: includes passive stretching, static weight-bearing exercises, strength training and fitness training.
• Electrical stimulation
• Constraint-induced therapy: restraining the less affected arm. Seems promising.
• Orthoses (external devices to modify structural and functional characteristics of the musculoskeletal system): seem to have short-term effects, but the long-term effects are still unclear.
• Oral medications: include benzodiazepines, baclofen, sodium dantrolene, tizanidine, alpha2-adrenergic agonists, gabapentin and tigabine. Many act via decreased excitation via glutamate, increased inhibition via GABA, or both. The most useful anti-spasticity agent is diazepam (Valium, a benzodiazepine), but it may cause drowsiness. Baclofen (a structural analogue of GABA) can help in spasticity related to spinal cord dysfunction. Sodium dantrolene, the only oral medication that affects the muscles and not the brain (if I remember correctly), is infrequently used due to liver toxicity.
• Intramuscular medications: generally work by causing neuromuscular blockade. Intramuscular phenol and alcohol are neurolytic (block nerves by injuring them). Botulinum toxin type A is a frequently used chemodenervation agent that prevents acetylcholine release at the neuromuscular junction. Effects of botulinum toxin last 8-12 weeks, but effects can last for a longer time if combined with another treatment (orthoses, physiotherapy, etc.). Even though botulinum toxin has limited long-term effects, it can reduce the need for complex surgery.
• Intrathecal (into spinal cord) baclofen.
• Hippotherapy (horse riding)
• Hyperbaric oxygen therapy: lacks evidence of efficacy. Furthermore, it is not risk-free: patients have had seizures following hyperbaric oxygen therapy.
• Adeli suit treatment: use of suits that provide resistance to movement).
• Acupuncture

References

Papavasiliou, AS 2009, ‘Management of motor problems in cerebral palsy: A critical update for the clinician’, European Journal of Paediatric Neurology, vol. 13, no. 5, pp. 387-396.