Monday, July 23, 2018

Risperidone for choreoathetoid cerebral palsy

Kamate M, Mittal N, Metgud D. Effect of Risperidone on the Motor and Functional Disability in Children With Choreoathetoid Cerebral Palsy. Pediatr Neurol. 2018 Jul;84:46-48.


Therapeutic options for management of choreoathetoid cerebral palsy, which is a permanent disorder, are limited. Available medications either have significant side effects or are unsuitable for long-term use. Risperidone has shown promise in the management of chorea and has been found to be safe in children less than five years.

Children with choreoathetoid cerebral palsy were enrolled after parental consent and given risperidone for six-month period along with standard care. The choreoathetoid movements were assessed using Abnormal Involuntary Movement Scale, the upper-limb functions were assessed using Quality of upper extremity skill tests, and the quality of life using Cerebral palsy-Quality of life. Side effects were monitored clinically, by biochemical tests and electrocardiogram.

Of 42 children with choreoathetoid cerebral palsy who were screened over a period of one year, 35 subjects meeting the study criteria were enrolled. Thirty children completed six months of risperidone therapy, the remaining five subjects were excluded because of time missed due to intercurrent unrelated illnesses. Data of these 30 children were analyzed as per per-protocol analysis. Their mean age was 6.35 ± 3.17 years. Abnormal movements showed statistically significant decline after risperidone (19.7 vs 14.7, P < 0.0001). Functional ability of upper limbs and quality of life also showed improvement (37.0 vs 43.8, P < 0.0001 and 64.3 vs 70.0, P < 0.0001, respectively) after six months of risperidone therapy. Positive change in the behavior was also noted. It was well tolerated without significant side effects.

Risperidone is a promising drug to manage children with choreoathetoid cerebral palsy and is well tolerated in children.

Risperidone significantly reduced the symptoms of abnormal movement and improved quality of life in children with choreoathetoid cerebral palsy (CP) and was well-tolerated, according to a study recently published in Pediatric Neurology.

Researchers treated a group of young patients with CP with risperidone for 1 year. Patients were enrolled at a teaching hospital in India, following parental consent. Of the initial 42 children, 35 met the study criteria, and 5 were excluded due to time missed for unrelated illnesses. The 30 children who completed 6 months of risperidone therapy had a mean age of 6.35 ± 3.17 years. In the study, the average dose of risperidone used was 0.75 mg, with a maximum dose of 2 mg/day. An equal number of boys and girls participated in the study. 

Scores from the Abnormal Involuntary Movement Scale and Upper Extremity Skill Test (QUEST) were compared before and after treatment. In addition, a quality of life assessment—the CP-Quality Of Life questionnaire—was used. QUEST scores noted an increased ability to complete everyday tasks and showed significant improvements to participants' motor skills in their upper extremities. Researchers also note that better upper-body control improved quality of life for school-aged children.

Overall, the risperidone treatment had few side effects. Mild side effects such as drowsiness were reported early in the study, but the researchers found no serious side effects overall. The study also notes the benefits of risperidone in several areas: the ease of use and availability of the treatment, a positive impact on behavior in some cases, and fewer sleep disturbances among children in the study.
Researchers conclude that “[risperidone] is a promising drug to manage children with choreoathetoid [CP] and is well tolerated in children,” but also caution "these findings need to be interpreted cautiously and need further validation due to potential limitations of the study."

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