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Management of hypertonia in cerebral palsy

Nahm, Nickolas, J.a; Graham, H., Kerrb; Gormley, Mark, E., Jr.c; Georgiadis, Andrew, G.d

doi: 10.1097/MOP.0000000000000567
ORTHOPEDICS: Edited by Daniel W. Green

Purpose of review The review provides an update on the treatment of hypertonia in cerebral palsy, including physical management, pharmacotherapy, neurosurgical, and orthopedic procedures.

Recent findings Serial casting potentiates the effect of Botulinum neurotoxin A injections for spasticity. Deep brain stimulation, intraventricular baclofen, and ventral and dorsal rhizotomy are emerging tools for the treatment of dystonia and/or mixed tone. The long-term results of selective dorsal rhizotomy and the timing of orthopedic surgery represent recent advances in the surgical management of hypertonia.

Summary Management of hypertonia in cerebral palsy targets the functional goals of the patient and caregiver. Treatment options are conceptualized as surgical or nonsurgical, focal or generalized, and reversible or irreversible. The role of pharmacologic therapies is to improve function and mitigate adverse effects. Further investigation, including clinical trials, is required to determine the role of deep brain stimulation, intraventricular baclofen, orthopedic procedures for dystonia, and rhizotomy.

aDepartment of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA

bDepartment of Orthopaedics, The Royal Children's Hospital, Parkville, Victoria, Australia

cDepartment of Physical Medicine and Rehabilitation

dDepartment of Orthopaedic Surgery, Gillette Children's Specialty Healthcare, St. Paul, Minnesota, USA

Correspondence to Andrew G. Georgiadis, MD, Gillette Children's Specialty Healthcare, 200 University Ave E, St. Paul, MN 55101, USA. Tel: +1 651 578 5636; e-mail:

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