Antispasmodics (muscle relaxants) for cerebral palsy
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How It Works
Antispasmodic medicines relax muscles and reduce muscle spasms. Specifically, diazepam relaxes the brain and body, baclofen blocks signals between the spinal cord and the muscles, and dantrolene interferes with muscle contraction.
Why It Is Used
Antispasmodics are used before physical therapy for cerebral palsy or at bedtime to help relax tight muscles and stop muscle spasms. Diazepam (such as Valium) helps relax muscles after orthopedic surgery.
How Well It Works
Although antispasmodics can help relax muscles temporarily, they have not been proved to improve general muscular function.1 Diazepam (Valium) may be of some use in people with CP whose emotional stress contributes to their spasms or abnormal movements.2
The most common side effects of oral antispasmodics include:
- Skin rash.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
These medicines may become ineffective when used over long periods.
Children taking these medicines may have difficulty paying attention in school. The long-term effects of oral antispasmodics on children have not been studied enough to guarantee safety.
Dantrolene sodium (Dantrium) may cause liver damage. Frequent blood tests are needed to check liver functioning when a person is taking this medicine.
Diazepam (such as Valium) cannot be used in people who have glaucoma.
Baclofen (Lioresal) may also be given directly into the fluid surrounding the spinal cord (intrathecal baclofen). A small pump is placed under the skin of the abdomen. Medicine is carried through a tube attached to the pump into the fluid surrounding the spinal cord. The pump is programmed to release a continuous amount of medicine. So far, the benefits of giving baclofen this way include:
- Reduced medicine needs. Because intrathecal baclofen is given right into the spinal fluid, it takes less medicine to be effective than with pills. This reduces side effects such as nausea and drowsiness, which are a problem with the oral form of the medicine.3
- Improved muscle tone and function.
Disadvantages of using baclofen through a pump include the following:
- Surgery is needed to place the pump under the skin in the abdomen.
- The pump and surgery are expensive.
- After the pump is inserted, it needs to be filled with medicine every 2 to 3 months.
- The insertion of the pump carries a risk of infection.
- In rare cases, problems with the pump, such as failure or breakage, result in sudden withdrawal. Symptoms such as itching, rebound spasticity, and rapid heartbeat may be noticed. Other malfunctions can cause an overdose and lead to breathing problems and coma.
- Liptak GS (2001). Cerebral palsy. In RA Hoekelman, ed., Primary Pediatric Care, pp. 468–473. St. Louis: Mosby.
- Wollack JB, Nichter CA (2003). Cerebral palsy section of Static Encephalopathies. In CD Rudolph, AM Rudolph, eds., Rudolph's Pediatrics, 21st ed., pp. 2197–2202. New York: McGraw-Hill.
- Tilton AH (2004). Management of spasticity in children with cerebral palsy. Seminars in Pediatric Neurology, 11(1): 58–65.
Last Updated: October 14, 2008