Drug-to-drug interaction between sodium valproate and trihexyphenidyl in a child with extrapyramidal cerebral palsy and epilepsy.

摘要

Sirs, The term cerebral palsy refers to a group of motor impairment syndromes secondary to non-progressive disorders of early brain development. Neurologic classification into spastic and extrapyramidal cerebral palsy (EPCP) types is based on specific abnormal motor patterns. Children with EPCP characteristically display rigid hypertonicity on examination, with athetoid, choreic, dystonic, hemiballis-mic, or bradykinetic movements. Magnetic resonance imaging (MRI) of the brain has revealed a variety of lesions in EPCP patients, including the selective vulnerability of specific regions of the basal ganglia and thalamus to acute perinatal hypoxic-ischemic insults, and recognized genetic-metabolic disorders [1]. Several medications have been used to treat dystonia, with effectiveness assessed by both etiology and dystonia severity. Oral pharmacology therapies include anthicolinergic agents, such as trihexphe-nidyl, baclofen, clonazepan, and levodopa. Trihexyphenidyl is a centrally active antimuscarinic agent that is commonly used in the management of movement disorders in EPCP. The dose of trihexyphenidyl used in children varies considerably (range 0.15-2.0 mg/kg/day), and it has been suggested that children tolerate higher doses of trihexyphenidyl than adults, particularly when the dose increase is gradual [2].