Pediatrics: Cerebral Palsy: Medical, Surgical, Pharmacological Interventions Flashcards
Pharmacological: Oral Medications Purpose
- Pre-synaptic inhibition of acetylcholine release
Pharmacological: Baclofen: Site of action
- Central Nervous System
Pharmacological: Baclofen: Pros
- Decreases spasticity and spasms
Pharmacological: Baclofen: Cons
- Decreased strength
- May lose postural control
Pharmacological: Diazepam: Site of action
- Central Nervous System
Pharmacological: Diazepam: Pros
- Improves motor control
Pharmacological: Diazepam: Cons
- Difficult to maintain steady state
Pharmacological: Tizanidine: Site of action
- Central Nervous System
Pharmacological: Tizanidine: Pros
- Noninvasive
- Not permenant
Pharmacological: Tizanidine: Cons
- Following dosage schedule may be difficult
Pharmacological: Dantrolene: Site of action
- Muscle
Pharmacological: Dantrolene: Pros
- Can be effective for some patients
Pharmacological: Dantrolene: Cons
- Side effects of drowsiness, hypotonia
Pharmacological: Intrathecal Baclofen Pump
- Catheter delivers drug to the intrathecal space
- Baclofen is a GABA b-agonist, which in an INHIBITORY CNS neuro transmitter
- Intrathecal administration allows for less medication to be administered
- Baclofen is a muscle relaxer
- Can be administered at a specific spinal level and relax muscles below that level
Pharmacological: Intrathecal Baclofen Pump: Pros
- Longer lasting
- Decreased spasticity/spasm
- improves motor control
- Reversible
- Non-invasive dose
- Fewer side effects
- Reservoir holds 1-4 month supply
Pharmacological: Intrathecal Baclofen Pump: Cons
- Side effects can include hypotonia
- Nausea
- Headaches
- Catheter kink/malfunction
- Overdose and withdrawal
- Refills needed approx every three months
Pharmacological: Intrathecal Baclofen Pump: Red Flag
- Abrupt withdrawal of Baclofen may result in exaggerated rebound effects
Neurosurgery: Selective Dorsal Rhizotomy
- Abnormal dorsal sensory nerve roots are severed
Neurosurgery: Selective Dorsal Rhizotomy: Pros
- Decrease spasticity
- Improved motor control
- Not reversible
Neurosurgery: Selective Dorsal Rhizotomy: Cons
- Possible sensory loss
- Not reversible
- Not effective for Dystonia
- Anesthesia risks
Peripheral Nerve Block
- Injection of phenol into peripheral nervous system from nerve root to motor end plate
- Lasts 3-6 months
Peripheral Nerve Block: Anesthetic/Diagnostic Nerve Blocks: Pros
- Decreases local spasticity and dystonia
- Not permanent
- Decreases contracture
- Improves motor control
- Not systemic
Peripheral Nerve Block: Anesthetic/Diagnostic Nerve Blocks: Cons
- Not permanent
Peripheral Nerve Block: Neurolytic Nerve Blocks: Pros
- Decreases local spasticity and dystonia
- Not permanent
- Decreases contractures
- Improves motor control
- Not systemic
Peripheral Nerve Block: Neurolytic Nerve Blocks: Cons
- Not permanent
- Ethanol and Phenol - great skill is needed to inject, risk of paresthesias
Botox
- Minute amounts of botulinum toxin injected into the muscle paralyzing it for 4-6 months
- Only a certain amount of botulinum toxin can be given in one sitting. If spasticity is wide spread intrathecal infusion may be a better option
Botox: Pros
- Decreases local spasticity and dystonia
- Not permanent
- Decreases contracture
- Improves motor control
- No systemic effects
- Can be administer without anesthesia
- Lasts 4-6 Months
Botox: Cons
- Not permanent
- Expensive
- Hypotonia
