## Drug of Choice for Spasticity in Cerebral Palsy **Key Point:** Baclofen is the first-line oral antispasticity agent in pediatric cerebral palsy, particularly for lower limb spasticity. ### Mechanism & Pharmacology Backlofen is a GABA~B~ receptor agonist that acts at the spinal cord level to reduce the release of excitatory neurotransmitters, thereby decreasing muscle tone and reflex hyperexcitability. ### Clinical Use in Pediatrics - **Dosing:** Initiated at 5–10 mg/day in divided doses, titrated gradually over weeks to a maximum of 40–60 mg/day (or higher in some cases). - **Onset:** Takes 3–7 days for initial effect; maximum benefit seen at 4–8 weeks. - **Route:** Oral for chronic management; intrathecal baclofen (ITB) for severe, refractory spasticity. ### Advantages in Cerebral Palsy - Effective for both upper and lower limb spasticity. - Well-tolerated in children with minimal hepatic metabolism. - Allows continued physiotherapy and functional improvement. - Can be combined with other modalities (botulinum toxin, orthoses). **High-Yield:** Baclofen is preferred over dantrolene in children because it has fewer hepatotoxicity concerns and is more effective for spinal cord–mediated spasticity, which predominates in cerebral palsy. ### Side Effects to Monitor - Drowsiness, dizziness, weakness (dose-dependent). - Abrupt withdrawal can cause rebound spasticity and seizures — taper slowly. - Rare: hallucinations, confusion in higher doses. **Clinical Pearl:** Intrathecal baclofen pump is reserved for children with severe, generalized spasticity unresponsive to oral therapy and is increasingly used in advanced cerebral palsy management.
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