Treatment of Spasticity in Cerebral Palsy/ Serebral Palside Spastisite Tedavisi

• Published in: Güncel pediatri Vol. 14; no. 3; p. 136
• Main Authors: Civelek, Gul Mete, Atalay, Ayce
• Format: Journal Article
• Language: Turkish
• Published: Galenos Yayinevi Tic. Ltd 01.12.2016
• Subjects: Care and treatment; Causes of; Cerebral palsy; Complications and side effects; Pediatric research; Spasticity; Turkey
• ISSN: 1304-9054
• DOI: 10.4274/jcp.74755

The cerebral palsy diagnosis is a clinical one and it includes motor development delay, abnormal muscle tone and hyperreflexia. Muscle weakness, spasticity, loss of coordination, the continuation of the primitive reflexes and non-developed normal motor control are often seen in children with cerebral palsy. Spasticity is the velocity dependent increase in the resistance against passive muscle stretching. Spasticity treatment program should be established after detailed evaluation of degree and effects. Treatments to achieve optimal muscle tone include physical therapy and rehabilitation program, oral and injectable medications and surgical treatments. In the treatment of spasticity, a personalized physical therapy and rehabilitation program including stretching exercises should be in the treatment plans, absolutely. There is no consensus regarding the optimal application of pharmacotherapy for the treatment of spasticity in cerebral palsy. Oral medications such as baclofen, benzodiazepine, tizanidine and dantrolene can be used for the treatment of generalized spasticity. Oral drugs have significant side effects such as sedation and cognitive deficits. Chemodenervation with perineural phenol or ethanol injection or intramuscular injection of botulinum neurotoxin A can be used as treatment of localized spasticity. It is shown that botulinum neurotoxin type A is safe and effective in reducing spasticity in children. Most commonly used surgical technique for the treatment of spasticity in cerebral palsy is selective dorsal rhizotomy and it can be applied to selected cases. Treatment options that are used in the treatment of spasticity in cerebral palsy are discussed in this review. Keywords Cerebral palsy, muscle spasticity, treatment, drug treatment, rehabilitation Serebral palsi tanisi klinik bir tanidir ve motor gelisimde gerilik, anormal kas tonusu ve hiperrefleksiyi icerir. Serebral palsili cocuklarda kas gucsuzlugu, spastisite, koordinasyon kaybi, primitif reflekslerin devam etmesi ve normal motor kontrolun gelisememesi siklikla gorulur. Spastisite hiza bagimli olarak, pasif kas gerilmesine karsi artan direnctir. Spastisite derecesi ve etkileri acisindan ayrintili olarak degerlendirildikten sonra bir tedavi programi olusturulmalidir. Optimal kas tonusuna ulasabilmek icin yapilacak tedaviler genel olarak fizik tedavi ve rehabilitasyon programini, oral ve enjekte edilen ilaclari ve cerrahi tedavileri kapsar. Serebral palside spastisite tedavisinde ozellikle germe egzersizlerini iceren kisisellestirilmis bir fizik tedavi ve rehabilitasyon programi tedavi planlarinda mutlaka yer almalidir. Serebral palside spastisite tedavisi icin verilen farmakoterapinin optimal uygulamasi ile ilgili bir konsensus yoktur. Generalize spastisite tedavisinde baklofen, benzodiazepin, tizanidin ve dantrolen gibi oral ilaclar kullanilabilir. Agizdan alinan ilaclarin sedasyon ve kognitif defisit gibi onemli yan etkileri vardir. Lokalize spastisite tedavisi icin perinoral fenol ya da etil alkol enjeksiyonuyla kemodenervasyon ya da intramuskuler botulinum norotoksin A enjeksiyonu kullanilabilir. Botulinum norotoksin tip A' nin cocuklarda spastisiteyi azaltmada guvenilir ve etkili oldugu gosterilmistir. Serebral palside spastisite tedavisinde kullanilan cerrahi teknikler arasinda en sik kullanilani selektif dorsal rizotomidir ve secili olgularda uygulanabilir. Bu derlemede serebral palside spastisite tedavisinde kullanilan tedavi secenekleri yer almaktadir. Anahtar kelimeler Serebral palsi, kas spastisitesi, tedavi, ilac tedavisi, rehabilitasyon