Pharmacological and neurosurgical interventions for individuals with cerebral palsy and dystonia: a systematic review update and meta-analysis.

Abstract

AIM:

To update a systematic review of evidence published up to December 2015 for pharmacological/neurosurgical interventions among individuals with cerebral palsy (CP) and dystonia.

METHOD:

Searches were updated (January 2016 to May 2020) for oral baclofen, trihexyphenidyl, benzodiazepines, clonidine, gabapentin, levodopa, botulinum neurotoxin (BoNT), intrathecal baclofen (ITB), and deep brain stimulation (DBS), and from database inception for medical cannabis. Eligible studies included at least five individuals with CP and dystonia and reported on dystonia, goal achievement, motor function, pain/comfort, ease of caregiving, quality of life (QoL), or adverse events. Evidence certainty was evaluated using GRADE.

RESULTS:

Nineteen new studies met inclusion criteria (two trihexyphenidyl, one clonidine, two BoNT, nine ITB, six DBS), giving a total of 46 studies (four randomized, 42 non-randomized) comprising 915 participants when combined with those from the original systematic review. Very low certainty evidence supported improved dystonia (clonidine, ITB, DBS) and goal achievement (clonidine, BoNT, ITB, DBS). Low to very low certainty evidence supported improved motor function (DBS), pain/comfort (clonidine, BoNT, ITB, DBS), ease of caregiving (clonidine, BoNT, ITB), and QoL (ITB, DBS). Trihexyphenidyl, clonidine, BoNT, ITB, and DBS may increase adverse events. No studies were identified for benzodiazepines, gabapentin, oral baclofen, and medical cannabis.

INTERPRETATION:

Evidence evaluating the use of pharmacological and neurosurgical management options for individuals with CP and dystonia is limited to between low and very low certainty. What this paper adds Meta-analysis suggests that intrathecal baclofen (ITB) and deep brain stimulation (DBS) may improve dystonia and pain. Meta-analysis suggests that DBS may improve motor function. Clonidine, botulinum neurotoxin, ITB, and DBS may improve achievement of individualized goals. ITB and DBS may improve quality of life. No direct evidence is available for oral baclofen, benzodiazepines, gabapentin, or medical cannabis.

• Authors: Emma Bohn, Katherine Goren, Lauren Switzer, Yngve Falck-Ytter, Darcy Fehlings
• Journal: Developmental medicine and child neurology (Dev Med Child Neurol) Vol. 63 Issue 9 Pg. 1038-1050 (09 2021) ISSN: 1469-8749 [Electronic] England
• PMID: 33772789 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Systematic Review)
• Copyright: © 2021 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.

Chemical References

• Levodopa
• Trihexyphenidyl
• Botulinum Toxins
• Baclofen
• Clonidine

Topics

• Baclofen (administration & dosage, therapeutic use)
• Botulinum Toxins (adverse effects, therapeutic use)
• Cerebral Palsy (drug therapy, surgery, therapy)
• Clonidine (adverse effects, therapeutic use)
• Deep Brain Stimulation (adverse effects)
• Dystonia (drug therapy, surgery, therapy)
• Humans
• Injections, Spinal (adverse effects)
• Levodopa (therapeutic use)
• Neurosurgical Procedures
• Trihexyphenidyl (adverse effects, therapeutic use)