Original ArticleUse of Trihexyphenidyl in Children With Cerebral Palsy
Introduction
Cerebral palsy is the most common neurologic cause of impaired mobility in children. Fifteen percent to 25% of patients with cerebral palsy are estimated to present with dystonia [1] as a component of their motor disorders. Dystonia can cause functional impairment because of involuntary muscle contractions affecting the extremities, and is frequently associated with altered speech articulation, abnormal swallowing, and excessive drooling [2].
Although trihexyphenidyl has been used extensively in adults with movement disorders such as dystonia for more than 20 years, information is limited regarding the use of trihexyphenidyl in children. Evidence indicates that trihexyphenidyl may reduce the severity of dystonia [3], [4], [5], [6].
The current options for the medical management of generalized dystonia in children with cerebral palsy are very limited, and are restricted to anticholinergics such as trihexyphenidyl or dopamine agonists [7]. As an anticholinergic, trihexyphenidyl also has a potential role in the treatment of sialorrhea, which affects 10-58% of children with cerebral palsy [8], [9].
This study sought to review the clinical experience of the use of trihexyphenidyl in children with cerebral palsy for dystonia or sialorrhea or both, with special emphasis on benefits and tolerability.
Section snippets
Patients and Methods
A retrospective chart review was performed of all children with a diagnosis of cerebral palsy treated with trihexyphenidyl for dystonia or sialorrhea or both by the principal investigator (M.R.D.) over a 3-year period at the neurology outpatient clinic in a pediatric tertiary care hospital.
Data collected from medical records included demographic information, classification of cerebral palsy, comorbid conditions, concomitant treatments and medications, age at initial treatment with
Results
In total, 101 patients with cerebral palsy, aged 1-18 years, were treated with trihexyphenidyl during the study period. Sixty-one boys and 40 girls were included. Type of cerebral palsy according to distribution of weakness included: 62% quadriparesis, 22% hemiparesis, 8% diparesis, 6% triparesis, and 2% paraparesis. Other comorbid conditions were present in 74% of the children, including epilepsy (46.5%), developmental delay (31.6%), constipation (32.6%), and others (37.6%). The majority of
Discussion
Awareness of a dystonic component of motor disorders in children with cerebral palsy is rising, and is probably a contributory factor to unexpected outcomes of managing spasticity. In fact, dystonia can be more disabling than spasticity in some patients because it is triggered or increased by attempted voluntary movements, interfering with fine and gross motor activities, communication, and ease of care.
The pathophysiology of dystonia involves a dysfunction in the basal ganglia. The current
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