Article

AIM: To systematically review evidence for pharmacological/neurosurgical
interventions for managing dystonia in individuals with cerebral palsy (CP) to
inform a care pathway. METHOD: Searches included studies with a minimum of five
participants with dystonia in CP receiving oral baclofen, benzodiazepines
(clonazepam, diazepam, lorazepam), clonidine, gabapentin, levodopa,
trihexyphenidyl, botulinum toxin, intrathecal baclofen (ITB), or deep brain
stimulation (DBS). Evidence was classified according to American Academy of
Neurology guidelines. RESULTS: Twenty-eight articles underwent data extraction:
one levodopa, five trihexyphenidyl, three botulinum toxin, six ITB, and 13 DBS
studies. No articles for oral baclofen, benzodiazepines, clonidine, or gabapentin
met the inclusion criteria. Evidence for reducing dystonia was level C (possibly
effective) for ITB and DBS; level C (possibly ineffective) for trihexyphenidyl;
and level U (inadequate data) for botulinum toxin. INTERPRETATION: For dystonia
reduction, ITB and DBS are possibly effective, whereas trihexyphenidyl was
possibly ineffective. There is insufficient evidence to support oral medications
or botulinum toxin to reduce dystonia. There is insufficient evidence for
pharmacological and neurosurgical interventions to improve motor function,
decrease pain, and ease caregiving. The majority of the pharmacological and
neurosurgical management of dystonia in CP is based on clinical expert opinion.
WHAT THIS PAPER ADDS: Intrathecal baclofen and deep brain stimulation are
possibly effective in reducing dystonia. Current evidence does not support
effectiveness of oral medications or botulinum toxin to reduce dystonia. Evidence
is inadequate for pharmacological/neurosurgical interventions impact on improving
motor function, pain/comfort, and easing caregiving. The majority of the care
pathway rests on expert opinion.
CI - (c) 2018 Mac Keith Press.

Langue : ANGLAIS