Cerebral Palsy and Muscle Relaxants

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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.

Cerebral Palsy and Muscles

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 an 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, mostly 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. In some cases, an individual’s muscle tone can vary from too loose to too 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.

Consequences 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.

Muscle Relaxants

One strategy for treating spastic muscles and tight muscles is to use medications. Muscle relaxants, also known as antispasmodics, 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. If the side effects are too uncomfortable, doctors can try different types of muscle relaxants. 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.

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 blocking signals from the spinal cord to muscles.[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, which is sold under the brand names Dantrium and Revonto, acts as a muscle relaxant by interfering with how muscles contract. It has been shown to be 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. Liver toxicity is irreversible, so it must be carefully considered before using dantrolene.[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 there was no sedation reported after waking up the next day.

Other Muscle Relaxants

Other types of muscle relaxants that are used less often for CP include tizanidine. It may cause liver damage and cannot be used with blood pressure medicines.[5] It may cause dizziness, drowsiness, and dry mouth.

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