Cerebral Palsy and Anticonvulsants

Children with cerebral palsy often face a number of symptoms and complications that need to be controlled with treatment in order to live a normal or more comfortable life. One of these complications is epilepsy or a seizure disorder. Statistics from studies of children with CP have shown that anywhere between 25 and 35 percent experience seizures. These can be disruptive, frightening, and dangerous. Controlling seizures in children with CP is important.

A number of strategies may be employed to control seizures, but the main aim is to prevent them from happening or to reduce their frequency. Sometimes diet and certain types of therapy can help, but most useful are medication. A class of drugs called anticonvulsants has been proven the most helpful in controlling seizures, although they can cause some unwanted side effects.

Epilepsy and Cerebral Palsy

Cerebral palsy and epilepsy together are an example of how some conditions can often co-exist, but not be the cause of one or the other. CP does not necessarily cause seizures and epilepsy does not cause CP. Because CP is caused by brain damage, and any type of trauma to the brain can also cause epilepsy, these conditions often exist together in the same person. Between 25 and 35 percent of children with CP will experience seizures as well.

According to research a child with CP may experience any type of seizure, but secondary generalized seizures and complex partial seizures are most common. Partial seizures are less serious than generalized seizures and involve just one of the hemispheres of the brain.

A complex partial seizure affects the muscles involved in vision so a child experiencing this may have visual hallucinations or an impaired sense of space and distance. A secondary generalized seizure begins in one hemisphere and spreads to the other.

Controlling Seizures

Anticonvulsant medications are often needed to control seizures in children with CP, but there are other things that can be done to reduce their frequency and to ensure a seizure, once it starts, won’t lead to injuries. Once a seizure begins it can’t be stopped prematurely. However, those around the child can remove objects that may cause injury, support the head, tilt the child if he or she vomits, and make sure that the child is still breathing.

Certain measures are useful in controlling seizures by preventing them. These include having a healthy diet or trying a special diet called the Ketogenic diet. It is high in fat, but low in carbohydrates and protein. Medications can reduce the frequency of seizures, and medical marijuana has also been shown to be effective, if not controversial for children especially. Finally, when all else fails to control seizures and they are frequent and severe, surgery may be an option.

Anticonvulsant Drugs

Using anticonvulsant medications to control seizures is a common strategy. Many people find relief from frequent or even occasional seizures by using these medications. The anticonvulsant group of drugs includes a lot of different medications that work in different ways. What they all have in common is that they suppress the excessive electrical activity in the brain that leads to a seizure. Anticonvulsants are also known to stabilize mood and relieve certain types of pain.

If you have a child with CP and seizures your doctor may suggest anticonvulsants. Because there are so many drugs in this category, your child may need to try a few different medications before you find one that works with a minimum amount of side effects. Your doctor will ask you to monitor your child’s seizures and then determine if a new drug is needed or if the dose needs to be changed. Another issue may be that your child will develop a tolerance to the medication over time and need higher and higher doses or a combination of drugs. These measures can help, but also increase the risk of experiencing side effects.

Anticonvulsants Used to Control Seizures in Cerebral Palsy

Doctors have a lot of choices when it comes to prescribing anticonvulsant drugs for children with CP. Among the many drugs that fall into this class, there are five or so that are most commonly used for cerebral palsy seizures:

• This is a barbiturate and an anticonvulsant used to treat seizures associated with CP. It slows electrical activity in the brain, but it also can be habit forming and leads to tolerance. Side effects also include sedation, anxiety and agitation, confusion, and delirium. It is typically only used in the short-term and for children who can benefit from a drug that helps them sleep.
• This is a medication that can be effective in reducing seizures and it comes in regular and long-acting tablets. Possible side effects include diarrhea, constipation, weight loss, vision changes, poor balance, and trouble thinking.
• This is an anticonvulsant that is not habit-forming, which makes it a good choice for many children. On the other hand, it carries a small risk of causing life-threatening side effects. These include Stevens-Johnsons syndrome and toxic epidermal necrolysis. The risk is greatest with children of Asian heritage.
• Klonopin is a benzodiazepine, and it slows electrical activity in the brain. It is a muscle relaxant as well as an anticonvulsant, so it has the potential to have dual benefits for children with CP. The main issue with this drug is that it is habit forming and leads to tolerance over time. Drowsiness is also a side effect. Like phenobarbital, this drug should only be a short-term measure.
• This drug belongs to the class of anticonvulsants called carboxamides. It is well tolerated compared to other drugs but can cause drowsiness, nausea, vomiting, constipation, stomach pain, or headaches.

Anticonvulsants and Suicide

In 2008 the U.S. Food and Drug Administration issued a warning that all anti-seizure drugs have the potential to cause suicidal thoughts and behaviors. Children using these drugs should be monitored for any signs that this is happening. It is a rare side effect, but one that has the potential to be deadly. The risk is also higher with those anticonvulsants used over the long-term. This and other potential side effects must be weighed by parents and doctors against the benefits that children with CP and seizures get from them.

Seizures are a regular part of CP for a significant number of children living with this condition. Seizures can be scary and frightening, and they can also cause serious harm. They must be controlled to minimize harm and maximize comfort, and anticonvulsant medications are important in the defense against seizures and in preventing them in many children. These drugs won’t work for everyone, but for many, they provide a great deal of relief.