The use of tiagabine in pediatric spasticity management

Abstract

Tiagabine, developed as an anti-epileptic medication, has the potential to reduce spasticity. The purpose of the present study was to assess the effectiveness of tiagabine in decreasing spasticity and improving the functional abilities of children with spastic cerebral palsy (CP). Nine children (seven females, two males) with CP (six spastic quadriplegia, three moderate to severe spastic diplegia) were treated with tiagabine for a mean of 7.2 months. Median age was 4y 5mo (range 3y 2mo-10y). All children were non-ambulatory. According to the Gross Motor Function Classification System, six were Level IV and three were Level V. Only one child showed a median decrease >or=1.0 grade on the modified Ashworth scale in upper extremities, lower extremities, and overall. Another child had significant improvement in the Pediatric Evaluation of Disability Inventory Self-care score and improved feeding. None of the participants was found to have a significant improvement in motor function or a decrease in the number of motions (passive range of motion and muscle length test) that were limited. Reduction of nocturnal awakenings from painful spasms was reported in one child. Eight of the nine children experienced adverse side-effects during treatment. Although tiagabine was not found to be effective in decreasing children's spasticity or improving their function, its potential use in the relief of painful spasms associated with neurological conditions in the pediatric population warrants further investigation.

Interventions to improve upper limb function for children with bilateral cerebral palsy: a systematic review

“…A flow chart of the selection process is shown in Figure S1 (online supporting information). The full articles of these 63 studies were reviewed and 46 studies were subsequently excluded for the following reasons: diagnosis, age, sample size, design, intervention, and outcome measure . Of the remaining 17 studies, two articles reported data on mixed study samples consisting of participants with quadriplegia, diplegia, traumatic brain injury, and spinal cord injury (among others) or participants with quadriplegia, diplegia, hemiplegia, and ataxia .…”

Combinational Spinal GAD65 Gene Delivery and Systemic GABA-Mimetic Treatment for Modulation of Spasticity

“…While effective in modulating spasticity of different etiologies including spinal trauma, amyotrophic lateral sclerosis or central stroke, major side effects such as general sedation and progressive tolerance development often limit its chronic use [15], [16], [17]. The use of systemically-administered GABA-mimetic compounds such as tiagabine (GABA reuptake inhibitor) shows only a weak or no anti-spasticity effect in clinically-acceptable doses [18], which correlates with a relatively modest potentiation of brain [19], [20] or spinal parenchymal GABA release after systemic delivery (current data). In addition, currently available spinal drug delivery systems (such as epidural or intrathecal delivery) do not permit a spinal segment-restricted therapeutic effect.…”