Developmental Delay / Delayed Milestones


Spasticity

Since cerebral palsy affects the muscular movements of its sufferers, many anti-spastic medicines for CP target these muscles. These drugs work in different ways to inhibit the muscles and nerves of the body. The muscle relaxants used for treating cerebral palsy work by stopping the muscles from contracting. These medications cease or lessen the severity of several major symptoms occurring in cerebral palsy patients.

The three primary drugs used in treating symptoms associated with cerebral palsy are muscle relaxants. They are Diazepam, Baclofen, and Dantrolene.

Diazepam is a benzodiazepine, a type of muscle relaxant. Diazepam is also available by the name Valium. The drug acts on muscle contractions in the cerebral palsy patient, relaxing them.

Mechanism: Increases pre-synaptic inhibition of afferent at spinal cord level. Muscle relaxation by depressing monosynaptic and polysynaptic transmission.

Uses: It reduces generalized spasticity, hyperreflexia and painful muscle spasms. It improves sleep and reduces anxiety.

Side effects: Sedation increased drooling, ataxia, cognitive dullness.

Baclofen is another muscle relaxant that is used in treating symptoms of cerebral palsy. This drug is used to relax muscle spasms, which result in stiff muscles and limbs. This stiffening can cause a number of problems for the cerebral palsy children. While Diazepam works in the brain, Baclofen works in the spinal cord. The effect is that it lowers the amount of signals being sent to the muscles from the spinal cord. During Baclofen treatment, the muscle is more flexible and may respond to pediatric therapy better than before Baclofen treatment.

Mechanism: Altered release of excitatory neurotransmitters. Depresses monosynaptic and polysynaptic transmission

Uses: It reduces generalized spasticity, hyperreflexia and painful muscle spasms.

Side effects: Weakness, sedation, ataxia, nausea, impaired cognition, orthostatic hypotension, dizziness, depression etc.

Baclofen Withdrawal Syndrome:

Sudden withdrawal may result in a withdrawal syndrome which can be potentially serious. The syndrome is characterized by seizures, hallucinations, hyperthermia, dydesthesia, pruritis, and rebound spasticity.

Treatment of Baclofen withdrawal syndrome is immediate re-administration of Baclofen.

Dantrolene is another drug that relaxes the muscles and may provide relief for people suffering from cerebral palsy. Dantrolene sodium lessens the calcium concentration in the muscles around the bones (skeletal muscle). The muscles become less sensitive to signals from the brain and spinal cord. The chemical workings of Dantrolene are not fully understood, but the effects are generally seen as safe.

Mechanism: Peripheral mechanism of action is in the skeletal muscles. It has no significant effect on cardiac and smooth muscles.

Uses: it is useful for symptomatic relief of clonuses.

Side effects: Muscle weakness, hepato-toxicity, drowsiness.

Tizanidine: Derivative: alpha-2 adrenergic agonist

Mechanism: Reduces excitatory amino acid release. Depresses polysynaptic release.

Uses: Muscle relaxant

Side effects: Sedation, hypotension, depression, dry mouth, dizziness, hepatotoxicity.

Another muscle relaxant called Flexeril is also sometimes used to ease the pain associated with muscle contractions. Flexeril is only prescribed for short-term use.

There are several side effects of the muscle relaxants for cerebral palsy and the prescribing doctor should monitor them very closely. Chief among these is a dependence on the drugs, in which case the side effects of withdrawal could compound cerebral palsy symptoms. In all cases, long-term use of muscle relaxants for cerebral palsy has seen significant results in improvements of motor function, pain relief, and spasticity associated with cerebral palsy.

Other agents: Gabapentin, Lamotrigine, Cyproheptadine, Cannabinoid like, Clonidine, etc