What are some muscle tone management options for Cerebral Palsy?

There is no one therapy that works for every child who has cerebral palsy. If your doctors have decided that
your child does have cerebral palsy, a team of health care professionals can help identify specific needs and
then develop a treatment plan to help improve your child’s quality of life.
Although cerebral palsy cannot be cured, treatment will often improve a child’s capabilities. Many children
with cerebral palsy go on to enjoy near normal adult lives if their disabilities are properly managed. In
general, the earlier that treatment begins the better chance the child has of overcoming developmental
disabilities, or of learning new ways to accomplish the tasks that challenge them.
Muscle Tone Management:
• Oral medications
• Botulinum toxin injections
• Cutting some of the roots of the spinal nerves (Rhizotomy)
• Injection of medicine into the fluid around the spine (intrathecal delivery of mediation via an
implanted pump)
Your doctor will determine which, if any, these treatments might be appropriate for your child.
Abnormal muscle tone that is strongly influenced by body posture and/or position and/or movement:
Oral medications:
Medications are usually used as the first line of treatment to relax stiff, contracted or overactive muscles.
These drugs are easy to use and appropriate for children who may need only mild reduction in muscle tone
or who have widespread spasticity. The use of oral medication for the management of abnormal tone has
been disappointing. For spasticity, dantrolene, baclofen, diazepam and tizanidine have been used. Other
medications such as Artane have been used for dystonia and there are some preliminary reports of success
with modafinil. Medications for the dyskinesias, including dystonia, athetosis, and hemiballismus have been
equally disappointing.(Pranzatelli, 1996).
Botulinum toxin:
Botulinum toxin A therapy (Botox, Allergan, Corporation, Irvine, CA) is FDA approved for strabismus,
hemifacial spasm, cervical dystonia, severe primary axillary hyperhydrosis and for cosmesis (wrinkles).
Although approved throughout the world for treatment of spasticity in children with cerebral palsy, it is not
approved by the FDA in for this use in the United States It has been used as an off label drug for this
indication since the late 1980’s There are other preparations on the market including Dysport which is used
in Europe and Myobloc, which is Botulinum Toxin B which acts through a different mechanism than
Botulinum toxin A
Extensive literature exists to show to show that botox is effective for children and adults who have spasticity
and/or dystonia. A combination of muscle weakening and strengthening of the antagonist muscle may
minimize or prevent contracture development with bone growth. This type of intervention is used when a
limited number of muscles are causing deformities such as spasticity of the gastrocnemius muscle causing a
child to walk on their toes or hamstring spasticity being responsible for a crouch gait. Recovery of the
muscle tone occurs because of the sprouting of the nerve terminals, a process which peaks at approximately
60 days(Cosgrove et al., 1994).
Botox use in the upper extremity spasticity has been shown to improve cosmesis and function (Fehlings et
al., 2000; Yang et al., 2003). Although the evidence is not conclusive, it is not uncommonly performed.