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Pharmacological management of abnormal tone and movement in cerebral palsy
  1. Daniel E Lumsden1,2,
  2. Belinda Crowe3,
  3. Anna Basu4,
  4. Sam Amin5,
  5. Anita Devlin6,
  6. Yasmin DeAlwis4,
  7. Ram Kumar7,
  8. Rajib Lodh8,
  9. Claire T Lundy9,
  10. Santosh R Mordekar10,
  11. Martin Smith11,
  12. Jill Cadwgan1
  1. 1 Paediatric Neurosciences, Guy’s and St Thomas' NHS Foundation Trust, London, UK
  2. 2 Faculty of Life Sciences and Medicine, King’s College London, London, UK
  3. 3 The Neurodisability Service, Great Ormond Street Hospital for Children, London, UK
  4. 4 Paediatric Neurology, Royal Victoria Infirmary, Newcastle, UK
  5. 5 Paediatric Neurology, University Hospitals Bristol, Bristol, UK
  6. 6 Department of Paediatric Neurology, Great North Children’s Hospital, Newcastle Upon Tyne, UK
  7. 7 Paediatric Neurology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
  8. 8 Paediatric Neurorehabilitation, Leeds Children’s Hospital, Leeds, UK
  9. 9 Paediatric Neurodisability, Royal Belfast Hospital for Sick Children, Belfast, UK
  10. 10 Paediatric Neurology, Sheffield Children’s Hospital NHS Foundation Trust, Sheffield, UK
  11. 11 Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Dr Daniel E Lumsden, Guy’s and St Thomas' NHS Foundation Trust, London SE1 7EH, UK; daniel.lumsden{at}gstt.nhs.uk

Abstract

Background The evidence base to guide the pharmacological management of tone and abnormal movements in cerebral palsy (CP) is limited, as is an understanding of routine clinical practice in the UK. We aimed to establish details of motor phenotype and current pharmacological management of a representative cohort across a network of UK tertiary centres.

Methods Prospective multicentre review of specialist motor disorder clinics at nine UK centres, collecting data on clinical features and pharmacological management of children and young people (CYP) with CP over a single calendar month.

Results Data were collected from 275 CYP with CP reviewed over the calendar month of October 2017. Isolated dystonia or spasticity was infrequently seen, with a mixed picture of dystonia and spasticity ± choreoathetosis identified in 194/275 (70.5%) of CYP. A comorbid diagnosis of epilepsy was present in 103/275 (37.4%). The most commonly used medications for abnormal tone/movement were baclofen, trihexyphenidyl, gabapentin, diazepam and clonidine. Medication use appeared to be influenced separately by the presence of dystonia or spasticity. Botulinum toxin use was common (62.2%). A smaller proportion of children (12.4%) had undergone a previous neurosurgical procedure for tone/movement management.

Conclusions CYP with CP frequently present with a complex movement phenotype and comorbid epilepsy. They have multiple therapy, medical and surgical management regimens. Future trials of therapeutic, pharmacological or surgical interventions in this population must adequately encompass this complexity in order to be translatable to clinical practice.

  • neurodisability
  • neurology
  • pharmacology

https://doi.org/10.1136/archdischild-2018-316309

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    Footnotes

    • Contributors DEL designed the study, performed data collection and wrote the first draft of the manuscript. BC and AB advised on study design and performed data collection. AD, YD, RK, RL, CTL, SRM and MS collected data and advised on data analysis. JC aided with initial study design, collected data and reviewed early drafts of the manuscript. All authors reviewed and agreed on the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.