Dear Nicholas:

Thank you for a good profeccional question. As you know, cerebral palsy may comorbids with epilepsy. That's clonazepam could be useful here. However, there are NO evidence-based multicenter randomised placebo-controlled clinical trials. In other words, if at cerebral palsy you would like to treat comorbid epi, please use NO benzodiazepins (like clonazepam), but rather valproates etc.

All the best,

Konstantin Loganovsky, MD, PhD, prof., Kiev, Ukraine

Am J Ment Retard. 2002 Sep;107(5):376-410.

Benzodiazepine behavioral side effects: review and implications for individuals with mental retardation.

Kalachnik JE1, Hanzel TE, Sevenich R, Harder SR.

Author information

Abstract

Behavioral side effects associated with benzodiazepines (such as clonazepam, diazepam, and lorazepam) are an easily overlooked and underrecognized problem with individuals who have mental retardation and can be inadvertently confused with other behavioral or psychiatric conditions. Based upon a literature review, behavioral side effects occurred for 13.0% of 446 individuals with mental retardation who were prescribed benzodiazepines for either behavioral or psychiatric conditions (n = 138, 17.4%), epilepsy (n = 208, 15.4%), or other medical conditions such as myoclonus or cerebral palsy (n = 100, 2.0%). Behavioral side effects for individual benzodiazepines for which data were available ranged from 11.4% to 25.0%. Implications of nonrecognition are discussed, and clinical indicators suggesting review by appropriate medical personnel are provided.

PMID:

12186578

[PubMed - indexed for MEDLINE]

J Neurol Sci. 1993 Jul;117(1-2):54-60.

Treatment of spasticity in children with low dose benzodiazepine.

Dahlin M1, Knutsson E, Nergårdh A.

Author information

Abstract

In an attempt to investigate whether benzodiazepines at low dosage have a significant effect in reducing spasticity among children with cerebral palsy, we carried out a double-blind, placebo-controlled, cross-over study. Twelve children with either spastic diplegia or hemiplegia participated in this study. The mean age was 14 years. The restraint of passive knee movements was determined with a dynamic dynamometer and spastic stretch reflexes were measured as EMG activity in muscles stretched. Clonazepam was given at low dosage (0.02 mg/kg body weight). In each child measurements of passive restraint were made on 2 different days immediately before and 3 h after an i.m. injection of either clonazepam or placebo in randomized order. Clonazepam significantly reduced spastic restraint (P < 0.001) compared to non-significant reduction with placebo. The mean plasma concentration of clonazepam at time of spasticity evaluation was 21 mmol/l which is in the low dose range, far below conventional doses. The study thus shows a positive effect of low dose clonazepam in reducing spasticity in children when given as a single dose.

PMID:

8410067

[PubMed - indexed for MEDLINE]

Thanks a lot for your help Dr Loganovsky

I suppose there are none. recently, I tried to find out why it is recommended in pain, and did not find any evidence that it works. Nevertheless, it figures in the recommendations. The same seems to be true for most of the conditions where it is recommended. There are some hints in conditions such as orthostatic tremor or first-line treatment of status epilepticus. 

It has been postulated that spasticity relates rather to GABA B receptors than to GABA A receptors, so Baclofen would be worth a try. Anywhere, there is sedation as well.

Usually, CP is a mixed state, so there are some hyper- and hypokinetic elements as well as ataxia (the latter usually hidden by fixed spasticity and dystonia). So I presume that single treatments tackle rather parts of the problem.

Hi,

Yeah, I have found a lot of reviews for baclofen and some for other GABAa and GABAb agonists/allosteric modulators. However, I am really bemused how reviews are suggesting certain pharmaceutical agents when there is no evidence of their effectiveness on the symptoms of CP in humans.

The other thing which I am finding quite frustrating is that nearly all the controlled trials focus on spasticity and not on ataxia. I understand that spasticity is very important when people are getting dressed or transferring from one seat to another but the ataxia is equally as difficult to cope with for the patient and their carers. I know that some tests touch on this, such as the PEDI and the GMFM but none of the drugs actually target the ataxia specifically and I really do not see why.

Does anyone have any ideas?