Sometimes medication or surgery can help manage symptoms associated with cerebral palsy (CP). Your child’s doctor may recommend either or both to manage pain, spasticity, bone deformities, or seizures. Be sure to discuss potential side effects of treatment with the doctor. Medication or surgery is often used along with other approaches, such as physical therapy.

Medication

Medication is available for children with CP who have significant spasticity or seizures. Medication for spasticity may be taken by mouth or injection into the muscle or fluid surrounding the spinal cord. It is sometimes also given through an implanted pump system. Medication for seizures is usually given orally.

No child responds in the same way to a specific medication. And many medications do have side effects. Therefore, the medical team will carefully weigh the risks and benefits of each option and discuss them with you.

Antispasticity medications include:

• Baclofen (Lioresal):
• Dantrolene sodium (Dantrium)
• Diazepam (Valium)
• Tizanidine (Zanaflex)

Anti-seizure medications include:

• Valproic acid (Depakene)
• Diazepam (Valium)
• Phenytoin (Dilantin)
• Clonazepam (Klonopin)
• Carbamazepine (Tegretol)

Injection Therapy. Injection therapy is another approach for controlling the symptoms of CP, such as spasticity. It is used along with other therapies to improve function. Botulinum toxin (Botox) is an example of injection therapy for CP. A very small dose of the toxin is injected into the affected muscle to reduce spasticity and prevent deformity.

Though sometimes costly, injection therapy can be effective, and results are localized to the targeted area. However, skill is required to inject the desired location. And multiple injections may be needed because the effects are not permanent. Results may last three to six months.

Intrathecal Baclofen Therapy (ITB). With this type of drug therapy, a liquid form of the drug baclofen is delivered directly into the fluid around the spinal cord. This helps to reduce spasticity. Only very small amounts of medication are needed, limiting overall side effects. If your child is over age four and has a positive response to injection of baclofen, you may choose to have a pump system implanted. A small, continuous dose of the medication is delivered. This way, repeated injections are not necessary. This procedure requires brief general anesthesia and a highly experienced neurosurgeon.

Surgery

Two main types of surgery are used for CP. Neurosurgical treatments make improvements with the nervous system. Orthopedic surgeries can help correct problems with either soft tissue or bones. These surgeries may improve symptoms but don’t provide complete solutions. Intensive therapy follow-up is usually necessary following surgery.

Neurosurgical Treatments. A variety of procedures can address CP symptoms rooted in the neurological system. These procedures have permanent effects and sometimes have negative side effects. Surgery is considered if contractures or limited movement is not improved well enough by medication and therapy. Therefore, the medical and therapy team takes great care in discussing them with the family.
They include:

• Neurectomy
• Myelotomy This procedure is seldom used today.
• Rhizotomy
• Thalamotomy

Orthopedic Surgery. Orthopedic surgeons, along with the rest of the team, may consider surgery to correct problems with soft tissue or bony deformities. Soft tissue surgery is designed to relieve contractures and the effects of muscle tightness, such as joint dislocation. Surgery may involve cutting through a muscle or tendon (release) and sometimes reattaching it elsewhere.

Bone deformities may be present at birth. Or they may develop over time with CP because of an imbalance of muscle activity, spasticity or weakness. Surgeries to correct bone deformities and improve postural alignment include:

• Osteotomy
• Clubfoot (talipes equinovarus) corrections.
• Spinal fusion The procedure often requires insertion of rods or stabilization devices.

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