Cerebral Palsy and Muscle Relaxants

Fact Checked

The stiffness, rigidity, and spasms that many people with cerebral palsy experience are disruptive, uncomfortable, and even painful or interfere with swallowing and breathing. Muscle relaxants for cerebral palsy can help relieve these symptoms. Medication use is just one line of treatment for CP, used along with surgery, therapies, and other interventions.

How Muscles Are Affected By Cerebral Palsy

Cerebral palsy is a disorder of movement and muscles. It is related to nerve and brain damage. When these parts of the body are damaged, it affects the muscles and, therefore, how a person moves. The severity of this effect varies by individual, with some unable to walk while others struggle with balance.

The most common type of CP is spastic, which means that muscle tone is increased compared to someone without the condition. The increased tone makes the muscles stiff and rigid, and as a result, movements are spastic.

The spasms may affect one whole side of the body, mainly the legs, or in severe cases, all parts of the body, including the face and throat.

Less common types of CP affect balance, control of movements, and even the ability to swallow or talk. Sometimes, an individual’s muscle tone can vary from too loose to tight. This is called dyskinetic CP.

Other patients with the condition have varying symptoms that can’t be categorized as one type or another. Nearly all CP patients experience rigid and spastic muscles at least some of the time.

Complications of Spastic Muscles

Controlling spasms and relaxing rigid muscles is an essential part of treatment for CP. Having overly toned muscles resulting in spasms and rigidity is uncomfortable and can even be very painful.

Spasms can interfere with other types of treatment, like physical therapy, and can prevent a person from being able to sleep at night.

What Are Muscle Relaxants?

One strategy for treating spastic muscles and tight muscles is to use medications. Muscle relaxants are drugs that decrease muscle tone by acting on the central nervous system. The result is less stiffness and rigidity and smoother, less spastic movements of muscles.[1]

Muscle relaxants may also cause side effects, which may bother some people more than others. Doctors can try different types of muscle relaxants if the side effects are too uncomfortable. They might also recommend using them only when severe spasms interfere with sleep and other important functions.

Sedation is the main side effect of most types of muscle relaxants. In addition to relaxing muscles, they tend to relax the brain. Operating machinery while on these drugs is discouraged. They may also cause skin rashes, nausea, and weakness.

What Muscle Relaxants Are Used for Cerebral Palsy?

Muscle relaxants include antispastics and antispasmodics. Antispastics are used to treat cerebral palsy. These are some of the common antispastic muscle relaxants doctors may prescribe for patients with cerebral palsy.

Baclofen

Baclofen is a muscle relaxant used in children and adults with CP. Brand names for this drug include Gablofen and Lioresal.

It is thought to reduce spasticity by acting on spinal cord nerves.[2] It can be dosed orally or injected directly into the spinal column. The latter method is newer and delivers the medication directly to the location where it is needed.

A small device implanted under the skin delivers baclofen directly to the spinal fluid.  Baclofen can cause fatigue, weakness, dizziness, nausea, and sedation and may also elevate liver enzymes.

Dantrolene

Dantrolene, sold under the brand names Dantrium and Revonto, acts as a muscle relaxant by interfering with how muscles contract. It is as effective, or more so, for children with CP than diazepam and is often better tolerated.

Side effects include weakness, malaise, diarrhea, and drowsiness, but the most serious potential side effect is toxicity to the liver. The medication must be stopped if it impairs liver function.[3]

Diazepam

Diazepam, also known as Valium, is a benzodiazepine, a type of drug that has the potential for abuse and dependence. Diazepam works by relaxing the brain and the body by acting on neurotransmitters in the brain.

It can trigger withdrawal symptoms if use is abruptly stopped. Common side effects are depression, sedation, and cognitive difficulties.

One study that investigated the use of diazepam in children found that most children saw positive benefits and minimized adverse outcomes when given one dose before bedtime.[4]

The medication helped their muscles relax so they could engage in therapeutic stretching before bed. The effects of the stretching lasted into the following day, and no sedation was reported after waking up the next day.

Other Muscle Relaxants

Another type of muscle relaxant used less often for CP is tizanidine. It may cause liver damage, dizziness, drowsiness, and dry mouth.[5]

Flexeril is another less common muscle relaxant for CP. It is indicated for muscle spasms and may cause drowsiness, nausea, stomach upset, dizziness, diarrhea, or constipation.

Muscle relaxants used to treat CP can be useful and, for many patients, provide much-needed relief from pain and discomfort. On the other hand, they come with some risks and can cause sedation and other side effects that are hard to live with when trying to perform daily functions.

As research progresses, more medications may be on the horizon that can help these patients feel better with fewer side effects.