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Trihexyphenidyl in young children with dystonic cerebral palsy: A single arm study
Lavanya Rajkumar1, Abhinaya Ventatakrishnan1, Smitha Sairam1
1Department of Paediatrics, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India.
Insights
Trihexyphenidyl effectively reduced dystonia and improved motor function and development in young children with dystonic cerebral palsy. This treatment shows promise for managing this challenging condition in pediatric patients.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Movement Disorders
Background:
- Dystonic cerebral palsy (CP) incidence and associated morbidity are increasing.
- Limited evidence exists for effective management strategies for dystonia in children.
Purpose of the Study:
- To evaluate the efficacy of trihexyphenidyl in managing dystonia in young children with cerebral palsy.
- To assess the impact of trihexyphenidyl on motor function and developmental progress.
Main Methods:
- A prospective study involving 41 children (6 months-5 years) with predominantly dystonic CP.
- Children received trihexyphenidyl (0.25-0.52 mg/kg) with follow-up at 3, 6, and 12 weeks.
- Evaluations included the Global Dystonia Scale (GDS), Gross Motor Function Measure (GMFM), and Early Developmental Profile-2.
Main Results:
- Significant reduction in dystonia severity (GDS scores decreased, p < 0.0001).
- Improved motor function with increased GMFM scores (median 19.8% to 26.5%, p < 0.0001).
- Enhanced fine motor skills and a notable increase in children classified in Gross Motor Function Classification System levels 1 and 2.
Conclusions:
- Trihexyphenidyl demonstrated significant benefits in improving dystonia, motor function, and development in children with dystonic CP.
- Further research with larger cohorts is warranted to confirm trihexyphenidyl's role in pediatric dystonic CP management.
Purpose:
The incidence of dystonic cerebral palsy causing significant morbidity is on the rise. There is a paucity of evidence for the management of dystonia in children.
Methods:
Forty-one children aged 6 months-5 years with predominantly dystonic cerebral palsy were started on a predetermined protocol of trihexyphenidyl (0.25-0.52 mg/kg) and followed up at 3, 6 and 12 weeks. Dystonia severity, motor function and developmental age at baseline and 12 weeks were compared using the Global Dystonia Scale (GDS), the Gross Motor Function Measure (GMFM), and Fine Motor/Perceptual Subscale of the Early Developmental Profile-2. Thirty-four children completed the entire 12 weeks of intervention.
Results:
The mean age of participants was 25±11 months. A significant decrease in median total dystonia scores on the GDS was observed post-intervention (74.5 to 59, p < 0.0001), and 64% of participants gained motor milestones. GMFM scores increased significantly from a median of 19.8% pre-intervention to 26.5% post-intervention (p < 0.0001). There was improvement in the fine motor domain as compared to the baseline (p < 0.0001). The number of children classified at Gross Motor Function Classification System levels 1 and 2 increased to 47.05% from 5.88% in the pre-intervention group.
Conclusion:
Trihexyphenidyl significantly improved dystonia, motor function and development in children with dystonic cerebral palsy in this study. Additional studies are needed to clarify its role in larger numbers of children with this condition.
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