Elsevier

Pediatric Neurology

Volume 44, Issue 3, March 2011, Pages 202-206
Pediatric Neurology

Original Article
Use of Trihexyphenidyl in Children With Cerebral Palsy

https://doi.org/10.1016/j.pediatrneurol.2010.09.008Get rights and content

A paucity of information exists regarding medications to treat dystonia in children with cerebral palsy. This study sought to review the benefits and tolerability of trihexyphenidyl in children with cerebral palsy, treated for dystonia or sialorrhea or both in a pediatric tertiary care hospital, through a retrospective chart review. In total, 101 patients (61 boys and 40 girls) were evaluated. The mean age at drug initiation was 7 years and 10 months (range, 1-18 years). The mean initial dose was 0.095 mg/kg/day. The dose was increased by 10-20% no sooner than every 2 weeks. The mean maximum dose reached was 0.55 mg/kg/day. Ninety-three patients (91%) tolerated the medication well, with a mean duration of treatment of 3 years and 7 months. Side effects occurred in 69% of subjects, the majority in patients aged ≥7 years, and soon after treatment initiation. Sixty-four percent continued the treatment at study end. Ninety-seven patients reported benefits, including reduction of dystonia in upper (59.4%) and lower (37.6%) extremities, sialorrhea (60.4%), and speech issues (24.7%). The majority of patients tolerated trihexyphenidyl well on a schedule of gradual dose increases, and almost all demonstrated improvements in dystonia or sialorrhea or both.

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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