Selection of treatment modalities in children with spastic cerebral palsy

Neurosurg Focus. 2006 Aug 15;21(2):e4. doi: 10.3171/foc.2006.21.2.5.


The purpose of this report was to outline the various options currently used for treatment of spastic cerebral palsy (CP) and to discuss factors involved in selecting the appropriate treatment modalities for the individual child. In a review of the literature and his personal observations, the author presents an outline of treatment options and the criteria for using each. Therapeutic options include the following: physiotherapy; occupational therapy; oral spasmolytic and antidystonic drugs; botulinum toxin injections; orthopedic procedures; continuous infusion of intrathecal baclofen (ITB); selective dorsal rhizotomy (SDR); and selective peripheral neurotomy. The most commonly used neurosurgical procedures are ITB pump placement and SDR, and these are discussed in the most detail. The author's personal schema for assessment of the child to determine the nature of the hypertonia, the impact of the hypertonia, and the appropriate therapeutic intervention is presented. There are factors that help guide the optimal treatment modalities for the child with spastic CP. The treatment of these children is optimized in the setting of a multidisciplinary team.

Publication types

  • Review

MeSH terms

  • Baclofen / therapeutic use
  • Cerebral Palsy / complications
  • Cerebral Palsy / therapy*
  • Child
  • Child, Preschool
  • Clinical Protocols
  • Humans
  • Muscle Relaxants, Central / therapeutic use
  • Muscle Spasticity / etiology
  • Muscle Spasticity / therapy*
  • Orthopedic Procedures / methods
  • Physical Therapy Modalities
  • Rhizotomy / methods


  • Muscle Relaxants, Central
  • Baclofen