management of cerebral palsy in adults
Last edited 01/2019
Spasticity
Enteral muscle relaxant drug treatments
Enteral baclofen is the first-line drug treatment for adults with cerebral palsy and generalised spasticity causing:
- functional impairment or
- pain or
- spasms.
Enteral baclofen treatment should be started with a low dose and increase the dose gradually over about 4 weeks to achieve the optimum therapeutic effect.
If enteral baclofen is ineffective or not tolerated by adults with cerebral palsy and generalised spasticity:
- refer the person to a tone or spasticity management service or
- discuss other drug treatment options (including other enteral muscle relaxants) with a tone management specialist
Do not offer diazepam for spasticity in adults with cerebral palsy, except in an acute situation when spasticity is causing severe pain or anxiety.
Do not rapidly withdraw muscle relaxant drugs, particularly if adults with cerebral palsy have taken them for more than 2 months or at a high dosage. Reduce the dosage gradually to avoid withdrawal symptoms
Botulinum toxin type A injections
- consider referring adults with cerebral palsy for botulinum toxin type A treatment if: they have spasticity in a limited number of muscle groups that is:
- affecting their care (such as hygiene or dressing) or
- causing pain or
- impairing activity and participation, or
- a tone management specialist agrees that treatment targeted to focal muscle groups is likely to improve their function and symptoms
Neurosurgical treatments to reduce spasticity
These include:
- intrathecal baclofen
- selective dorsal rhizotomy
Dystonia
Refer adults with cerebral palsy and problematic dystonia (for example, causing problems with function, pain or participation) to a tone or spasticity management service to consider treatment options.
Enteral anti-dystonic drug treatments
Do not prescribe levodopa to manage dystonia in adults with cerebral palsy, except in the rare situation when it is used as a therapeutic trial to identify doparesponsive dystonia.
Do not rapidly withdraw enteral drugs for treating dystonia, particularly if adults with cerebral palsy have taken them for more than 2 months or at a high dosage. Reduce the dosage gradually to avoid withdrawal symptoms
Botulinum toxin type A injections
- should only consider botulinum toxin type A treatment for focal dystonia in adults with cerebral palsy when:
- the person is under the supervision of a tone or spasticity management service, and it
- is part of a wider programme of therapy and focal dystonia is:
- affecting their care (such as hygiene or dressing) or
- causing pain or
- impairing activity and participation
Neurosurgical treatment to reduce dystonia
Options include:
- intrathecal baclofen
- deep brain stimulation
Osteoporosis and fracture risk
Health care professionals should be aware that low bone mineral density is common in adults with cerebral palsy, particularly in people:
- with reduced mobility orreduced weight bearing
- taking anticonvulsants or proton pump inhibitors
- who have had a previous low-impact fracture.
Consider assessment for risk of fractures secondary to osteoporosis in adults with cerebral palsy. Risk factors to assess include:
- needing help with moving or having to be moved, for example, hoisting
- history of falls
- low BMI
- history of low-impact fractures
- other medical factors, for example steroid use, that may adversely affect bone health
Consider a dual-energy X-ray absorptiometry (DXA) assessment in adults with cerebral palsy who have 2 or more risk factors (see risk factors above), particularly if they have had a previous low-impact fracture.
Consider referring adults with cerebral palsy for specialist assessment and management, for example, to a rheumatology, endocrinology or bone health service, if they have: a high fracture risk or a positive DXA result
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