Medication For Spasticity
Is baclofen the least worst option for spasticity management in children?
Spasticity refers to abnormal muscle tightness due to prolonged muscle contraction, and is seen in individuals with neurological conditions such as cerebral palsy. As many parents know, dealing with their child’s spasticity can be challenging. When managing spasticity in children, baclofen is often considered a first-line medication. The author of this paper explains why in his practice, he often uses other medications such gabapentin, diazepam, and botulinum toxin, prior to starting baclofen.
The paper explains that the decision to use a medication depends on many factors including the severity of the spasticity, the impact of spasticity on the child’s function and/or care, the age of the child, dosing/availability of medication and the child’s other medical conditions. Surprisingly, there is no ideal medication for spasticity management as all medications have risks of adverse effects. This is what makes spasticity management so difficult.
Baclofen has some of the strongest evidence supporting its use in children with cerebral palsy. So why is the author lessening his use of baclofen as a first-line medication? The paper explains that studies on baclofen use in children with cerebral palsy have shown mixed results, with even randomized trials sometimes showing no improvement at all. Baclofen can also have side effects such as sedation, constipation and seizures. For children with CP, the combination of sedation and spasticity reduction for example may worsen existing challenges in learning, cognitive impairment, feeding and positioning. Baclofen can also be challenging to dose and administer for children, creating the risk of under- or over-dosing. So, baclofen may not be the best option for some patients depending on their needs.
What does this mean for parents trying to manage with their child’s spasticity? The paper says it’s important to understand that there isn’t one medication solution for all children. Parents should talk to their child’s healthcare provider to select an appropriate option for their child’s unique needs.
The paper ultimately recommends an evidence-based, patient- and family-centric approach that incorporates spasticity severity, patient goals and side effects. While the paper does not propose a particular medication option, it gives us a better understanding of the important role parents play in communicating their child’s needs and concerns to health care providers when selecting medication.
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