A new guideline issued by the American Academy of Neurology (AAN) identifies botulinum toxin type A as an effective treatment for spasticity in children and adolescents with cerebral palsy. The guideline, published in the January 2010 issue of Neurology, also recognizes the risks associated with the treatment.
Spasticity is a condition in which certain muscles are continuously contracted; symptoms range from mild muscle stiffness to painful and uncontrollable muscle spasms. Spasticity in children is most commonly caused by cerebral palsy, a neurological disorder caused by brain abnormalities that affect movement. Most children with cerebral palsy have spasticity.
The AAN panel's conclusions were based on a review of more than 218 published studies, and the experts found that good data were lacking on many common treatments. Although the reviewers found botulium toxin type A to be effective for reducing spasticity in children with cerebral palsy, “it's still unclear whether it improves functionality,” according to lead guideline author Mauricio R. Delgado, M.D., with the University of Texas Southwestern Medical Center in Dallas. In fact, none of the available research provided conclusive evidence on a treatment's effectiveness in improving functionality, defined as a patient's motor skills.
The Food and Drug Administrative (FDA) is investigating cases where patients treated with botulinum toxin type A experienced weakness. However, Dr. Delgado says, “All the other medications used to treat spasticity have side effects as well.”
The guideline also found the drugs diazepam and tizanidine to be effective short-term treatments, although information about their effect on functional improvement was not available.
“More research needs to be done, not only on the medicines we already use, but also to find more medications,” says Dr. Delgado. “We need better and safer medications.”