Physician Approaches to the Pharmacologic Treatment of Dystonia in Cerebral Palsy

Abstract Objective To determine how physicians approach pharmacologic dystonia treatment in people with CP and assess physician readiness to participate in a randomized trial comparing existing pharmacologic dystonia treatments. Methods We administered a REDCap survey to physician members of the American Academy of Cerebral Palsy and Developmental Medicine and of the Child Neurology Society to assess which pharmacologic agents they use to treat dystonia in CP and their preferred indications and dosing. Results Of 479 physicians surveyed, 240 (50%) responded. Respondents treated functionally limiting (95%) and generalized (57%) dystonia and most commonly used six medications: baclofen (95%), trihexyphenidyl (79%), gabapentin (67%), carbidopa/levodopa (55%), clonazepam (55%), and diazepam (54%). Baclofen was preferred in people with co-existing spasticity (81%), gabapentin was preferred in people with co-existing pain (49%), and trihexyphenidyl was avoided in people with constipation (34%) or urinary retention (42%). Preferred dosing regimens followed published regimens for dystonia, when available, but otherwise followed published regimens for other CP symptoms (spasticity and seizures). Baclofen was preferred by 64% of respondents as first line treatment, but there was no clear consensus on second or third-line medications. Most respondents (51%) were comfortable randomizing their patients to receive any of the six most commonly used medications used to treat dystonia in CP. Conclusions This study summarizes current indications and dosing for the six most commonly used medications to treat dystonia in CP as per treating physicians in the US and Canada and also demonstrates physician support for a randomized trial comparing the effectiveness of these treatments. Article summary Dystonia is common and debilitating in people with CP, with little data on pharmacologic treatments. We describe physicians’ current approaches to using these treatments. What’s known on this subject Comparing the effectiveness of existing pharmacologic treatments for dystonia in CP is a research priority shared by clinicians and the community. However, current pharmacologic treatment practices are unknown. What this study adds Physicians in the US and Canada primarily prescribe a subset of six medications for the treatment of functionally limiting and generalized dystonia in CP: baclofen, trihexyphenidyl, gabapentin, carbidopa/levodopa, clonazepam, and diazepam. Contributors Statement Emma Lott helped design the study, carried out data analyses, and critically reviewed and revised the manuscript. Darcy Fehlings, Rose Gelineau-Morel, Michael Kruer, Jonathan Mink, Sruthi Thomas, and Steve Wisniewski helped design the study and critically reviewed and revised the manuscript. Bhooma Aravamuthan conceptualized and designed the study, supervised data collection and analysis, drafted the initial manuscript, and critically reviewed and revised the manuscript.