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Botulinum Toxin A
Though lethal in large doses, small pills or injections of Botulinum Toxin A (BTX-A) are can be an effective treatment for patients with spastic cerebral palsy.
BTX-A is a chemical that acts at the neuromuscular junction to prevent the release of the neurotransmitter acetylcholine.
If acetylcholine is not released, muscle fibers will not contract, so chronically tensed (hypertonic) muscles can be made to relax.
- Children treated with BTX-A walk farther with a steadier gait, while their gross motor function also improves with a minimum of side effects.
Selective Dorsal Rhizotomy (SDR):
By making selective incisions of dorsal roots of the spinal cord, neural communication to the tense muscles can be decreased, allowing these muscles to relax.
Besides reducing spacticity, SDR leads to permanent increases in muscle strength and flexibility.
There are side effects of this operation, however. By cutting the spinal cord, some sensory loss occurs as well. To combat this loss, a technique called transoperative electromyography (EMG) usually accompanies SDR surgery.
Other side effects:
Overcompensation: If muscle tone is decreased too much, weakness and flacidity can result. (hypotonia)
Persistent back pain and loss of bladder control are commonly reported.
- Lazareff et al. (1999) have pioneered a more limited surgical procedure in which only two (L5-S1) or three (L4-S1) dorsal roots are severed.
Prevention
Steroids: In utero exposure to steroids is known to decrease the incidence of congenital CP, especially in cases of infection or inflammation.
Prenatal stroke prevention: Research is underway to diagnose and treat possible cases of prenatal stroke, which could lessen the incidence of CP.
- Common sense/Postnatal prevention
: Use of child car seats, bicycle helmets, and counseling for abusive parents can help to prevent postnatal CP.
Other Treatments and Future Possibilities
Most cerebral palsy patients receive a physical, behavioral, and other therapies.
- Physical therapy
prevents muscular atrophy and contracture—a condition in which the child’s bones grow faster than the muscles attached to them, causing the muscles to become fixed in an abnormal position.
- Behavioral therapy
is aimed toward encouraging positive and eliminating destructive behaviors such as hair pulling by rewarding them for refraining from these activities.
- Hyperbaric oxygen (HBO2) therapy
: a relatively new technique, treating spastic children with HBO2 has been shown to both motor function and reduce overall spasticity. However, the treatment has not been shown to help long-term recovery.
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