Clinical Study On Trihexyphenidyl Combined With Physical Therapy In The Treatment Of Dystonia In Children With Cerebral Palsy

Objective: This study aims to observe its therapeutic effect on cerebral palsy children with dystonia through physical treatment with combination of trihexyphenidyl treatment of dystonia in children with cerebral palsy from two dimensions include structure and function,activity and participation,and to explore its possible mechanism and the factors wich can impact the treatment effect.salivation situation and drug resistance also been recorded.Finally to find a new method for the treatment of cerebral palsy children with dytonia.Methods: The research for clinical randomized double blind controlled study,parents signed informed consent,all existing dystonic cerebral palsy children were divided randomly into three groups according a random digital gouped table : group A as observation group and received physical therapy combined with oral administration of trihexyphenidyl therapy(n=22);group B for physical therapy group,received physical therapy(n=22),oral placebo as control;group C for drug treatment group(n = 11),received oral trihexyphenidyl therapy.The final cohortcomprised 51 children(41 boys,10 girls).At the baseline assessment,the age ofthesechildren ranged from 18 months to 72 months(32 months±9).Assessments were performed at baseline,8,and 16 weeks after commencement.Outcome measurements wre following by Barry-Albright Dystonia scale(BADs),Gross Motor Function Measuer-88(GMFM-88),Gross Motor Function Classification System(GMFCS),Fine Motor Function Measure(FMFM).At the same time,saliva situation,drug dosage and drug tolerance also been recorded.Analysis was performed using the Statistical Package of Social Science versionl 19.0(SPSS Inc.,Chicago,IL,USA).data).The factor of the baseline data which can influence the BADs improvementwas performed with Multivariate Regression analysiss.Significance was set at the 5%level.Results: 1.There was no stastically significant in baseline data(P>0.05).2.Childrenin group Aat the end of treatment(16 weeks)mean value of change of BADs score was-3.76±2.914,-0.71±3.288 in group B and-3.22±2.863 showed in goup C.the difference was statistically significant(F=6.570,P<0.01).The BADs score change rate was compared between 3 groups,and the difference was statistically significant(8 weeks after treatment,F=4.258,P<0.05,and F=5.289,P<0.01 in 16 weeks visit point).The improvement of BADs score of group A and C was better than that of group B(P<0.05).3.After the treatment,Repeated measures analysis showed all children were increased at the end of the treatment(16 weeks)in GMFM-88 score(the increased range ofgroup A was 8.01±5.760,group B was 3.88±3.309 and group C was 3.88±3.799),FMFM capacity target socre(the increased range of group A was 8.45±6.083,group B was 4.63±3.922and4.22±2.746 showed in group C);group B was 3.76±3.330 and 3.11±5.349 showed in group C).the FMFM target capacity socre showed satatistic significant of P<0.05,and the remaining two groups indicator of P<0.01.There was no significance of GMFM-88 score untill 16 week visit point between 3 groups(F=4.686,P<0.05),Group A revealed a better increase than group B and goup C(P <0.05).There was no significant difference in the gross motor function classification(GMFCS)between 3 groups after treatment(P>0.05).The FMFM target score increase showed a statistical difference at 16 week check point but not at 8week between the groups(F=4.117,P < 0.05).The FMFM taget score in group A was higher than group B and C(P<0.05).4.The improvement with salivation in group A was 87.5%,4.7% in group B and 83.3% in group C.The children in group A and C had made a greater progress than group B about salivation improvement(P<0.05).Statistically significantce didn't showed between group A and group B(P<0.05).5.The mean average peak dose oftrihexyphenidyl was 2.8±0.368mg/d,and the mean peak dose per weight was 0.25±0.012mg/kg/d.The drug was well tolerated without serious adverse events.6.There was no correlation between the BADs socre decrese and the age at base line(adjusted R~2=0.135,? =0.067,P=0.362)but positive correlation with the hyperkinetic feature(?=0.464,p=0.017)in group A.The BADs improvement of children with hyperkinetic feature was lower than who showed non-hyperkinetic feature(F=5.271,P<0.05).Conclusion: 1.The trihexyphenidyl combined with physical therapy may be a effective treatment for dystonia in some children with cerebral palsy in a certaintime compaired with conventional physical therapy and isolate trihexyphenidyl therapy.It's favorable to improve the dystonia severity,gross motor function and fine motor function.2.The trihexyphenidyl combined with physical therapy for dystonia in some children with cerebral palsy failed to further improvement in Gross Motor Function Classification System levels compaired with conventional physical therapy and isolate trihexyphenidyl therapy.3.The trihexyphenidyl combined with physical therapy for dystonia in some children with cerebral palsy unable to improve ptyalism compared with oral trihexyphenidyl alone.4.Children with hyperkinetic features may not benefit on trihexyphenidyl treatment of dystonia in children with cerebral palsytrihexyphenidyl.