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Trihexyphenidyl improves motor function in children with dystonic cerebral palsy: a retrospective analysis
1Movement Disorder Clinic, Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel. Benpazi@gmail.com
Insights
Trihexyphenidyl, an anticholinergic medication, shows effectiveness in treating cerebral palsy dystonia, particularly in children without spasticity and with higher cognitive function. This study highlights specific patient subgroups benefiting from this treatment.
Area of Science:
- Neurology
- Pediatrics
- Pharmacology
Background:
- Conflicting reports exist on trihexyphenidyl's efficacy for cerebral palsy (CP) dystonia.
- Anticholinergic medications are used, but subgroup effectiveness is unclear.
Purpose of the Study:
- To investigate the efficacy of high-dose trihexyphenidyl in children with CP dystonia.
- To identify subgroups of children who may benefit more from trihexyphenidyl treatment.
Main Methods:
- Retrospective analysis of 31 children with CP dystonia treated with high-dose trihexyphenidyl (>0.5 mg/kg/day).
- Motor improvement assessed by affected body areas; caregiver-reported outcomes and side effects documented.
Main Results:
- Most children (21/31) showed improvement in motor function, especially in arms, hands, and oromotor areas.
- Significant improvement noted in children without spasticity (P=.02) and those with higher cognitive function (P=.02).
- One-third reported tone reduction; half noted overall functional improvement. Side effects were mostly transient.
Conclusions:
- Trihexyphenidyl is effective for CP dystonia, particularly in children without spasticity and with higher cognitive abilities.
- Caregiver-reported functional and motor improvements support its use in selected pediatric CP populations.
- Further research into anticholinergic efficacy in specific CP subgroups is warranted.
Abstract:
There are conflicting reports regarding the efficacy of trihexyphenidyl, an anticholinergic drug, for treatment of dystonia in cerebral palsy. The author hypothesized that trihexyphenidyl may be more effective in specific subgroups and performed a retrospective analysis of 31 children (8.2 ± 5.8 years) with dystonia following treatment with high-dose trihexyphenidyl (>0.5 mg/kg/day). Main outcome measure was extent of motor improvement calculated according to the body areas affected. Most (21/31) caregivers reported improvement in 1 or more areas, mainly arm, hand, and oromotor function. Improvement was greater in children without spasticity (P = .02) and in those with higher cognitive function (P = .02). While a third of caregivers (10/31) reported tone reduction, and half (15/31) noted overall functional improvement. Side effects were transient, with the exception of hyperopia (n = 1), and occurred less frequently in children with a history of prematurity (P = .02). In summary, trihexyphenidyl is effective particularly in absence of spasticity and in children with higher cognitive abilities.
