格隆溴铵
已获批用于治疗患有神经系统疾病的 3 岁及以上儿童的多涎。[193]National Institute for Health and Care Excellence. Severe sialorrhoea (drooling) in children and young people with chronic neurological disorders: oral glycopyrronium bromide. Feb 2017 [internet publication].https://www.nice.org.uk/advice/es5/chapter/Key-points
干细胞治疗
在基础研究中,在细胞水平上干细胞如何分化成神经元、神经元细胞,这个过程涉及到各种信号,需要进一步阐明。 干细胞疗法还在临床试验阶段。[194]Singec I, Snyder EY. Quo vadis brain repair? A long axonal journey in the adult CNS. Cell Stem Cell. 2007 Oct 11;1(4):355-6.http://www.ncbi.nlm.nih.gov/pubmed/18371370?tool=bestpractice.com[195]Bartley J, Carroll JE. Stem cell therapy for cerebral palsy. Expert Opin Biol Ther. 2003 Jul;3(4):541-9.http://www.ncbi.nlm.nih.gov/pubmed/12831360?tool=bestpractice.com[196]Park KI, Himes BT, Stieg PE, et al. Neural stem cells may be uniquely suited for combined gene therapy and cell replacement: evidence from engraftment of neurotrophin-3-expressing stem cells in hypoxic-ischemic brain injury. Exp Neurol. 2006 May;199(1):179-90.http://www.ncbi.nlm.nih.gov/pubmed/16714016?tool=bestpractice.com 并且没有可信的证据表明干细胞迁移到受损区域合理,虽然在老鼠这似乎是可能的。随着干细胞研究的发展,在高危环境中细胞被证明可以诱导产生有神经保护作用的物质,如早产或者新生儿卒中。然而,在发达国家中干细胞治疗脑瘫没有被政府认可。在不受管制的区域,干细胞治疗产业已经在承诺、口碑及广告虚假宣传中成长,事实上被证明没有任何科学意义。患儿和他们的家属追求这样最昂贵和最坏的冒险治疗,干细胞治疗,这项治疗被大部分学者和参与者所摒弃。临床试验已进行宣传和发表:ClinicalTrials.gov 简洁的总结干细胞疗法的现状:Reaching for the Stars: stem cells - the hype, the hope and the reality
补充和替代疗法
这些方法通常不被临床医生提倡;根据定义,其功效未经过科学证实。然而,有很多脑性瘫痪的家庭对此很有兴趣。这些疗法包括针灸、高压氧治疗,Adeli适合治疗(类似服装系统把压力和支持融合到一块)、颅骶疗法、阈值电刺激等。[197]Zhang Y, Liu J, Wang J, et al. Traditional Chinese Medicine for treatment of cerebral palsy in children: a systematic review of randomized clinical trials. J Altern Complement Med. 2010 Apr;16(4):375-95.http://www.ncbi.nlm.nih.gov/pubmed/20423208?tool=bestpractice.com[198]Oppenheim WL. Complementary and alternative methods in cerebral palsy. Dev Med Child Neurol. 2009 Oct;51 Suppl 4:122-9.http://www.ncbi.nlm.nih.gov/pubmed/19740219?tool=bestpractice.com 一些非传统的治疗现在已经成为了主流,例如马术治疗(骑马治疗法)、[199]Snider L, Korner-Bitensky N, Kammann C, et al. Horseback riding as therapy for children with cerebral palsy: is there evidence of its effectiveness? Phys Occup Ther Pediatr. 2007;27(2):5-23.http://www.ncbi.nlm.nih.gov/pubmed/17442652?tool=bestpractice.com[200]Sterba JA. Does horseback riding therapy or therapist-directed hippotherapy rehabilitate children with cerebral palsy? Dev Med Child Neurol. 2007 Jan;49(1):68-73.http://www.ncbi.nlm.nih.gov/pubmed/17209981?tool=bestpractice.com[201]Zadnikar M, Kastrin A. Effects of hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: a meta-analysis. Dev Med Child Neurol. 2011 Aug;53(8):684-91.http://www.ncbi.nlm.nih.gov/pubmed/21729249?tool=bestpractice.com[202]Whalen CN, Case-Smith J. Therapeutic effects of horseback riding therapy on gross motor function in children with cerebral palsy: a systematic review. Phys Occup Ther Pediatr. 2012 Aug;32(3):229-42.http://www.ncbi.nlm.nih.gov/pubmed/22122355?tool=bestpractice.com[203]Mutoh T, Mutoh T, Tsubone H, et al. Impact of serial gait analyses on long-term outcome of hippotherapy in children and adolescents with cerebral palsy. Complement Ther Clin Pract. 2018 Feb;30:19-23.http://www.ncbi.nlm.nih.gov/pubmed/29389473?tool=bestpractice.com[204]Martín-Valero R, Vega-Ballón J, Perez-Cabezas V. Benefits of hippotherapy in children with cerebral palsy: a narrative review. Eur J Paediatr Neurol. 2018 Jul 10 [Epub ahead of print].http://www.ncbi.nlm.nih.gov/pubmed/30017618?tool=bestpractice.com 引导式教育和 MOVE 计划(Mobility Opportunities Via Education:通过教育获得运动机会)。在适合的患者中,钢琴训练呈现功能改善,但任何建立在患者特长和先天能力基础上的活动,都可以帮助他们开发和磨练新技能。[205]Lampe R, Thienel A, Mitternacht J, et al. Piano training in youths with hand motor impairments after damage to the developing brain. Neuropsychiatr Dis Treat. 2015 Aug 3;11:1929-38.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4529264/http://www.ncbi.nlm.nih.gov/pubmed/26345312?tool=bestpractice.com
虚拟现实系统
电脑以多种方式被用于残疾儿童互动并且可能在将来给人以希望。 其声称的好处是包括大脑重组,改善视觉知觉技能,参与社会互动。 迄今为止缺乏证据,实验上的证据缺少。[206]Snider L, Majnemer A, Darsaklis V. Virtual reality as a therapeutic modality for children with cerebral palsy. Dev Neurorehabil. 2010;13(2):120-8.http://www.ncbi.nlm.nih.gov/pubmed/20222773?tool=bestpractice.com 一项研究表明,脑瘫患儿中,通过上身倾斜运动的电脑游戏的应用能改善坐的能力。[207]Wade W, Porter D. Sitting playfully: does the use of a centre of gravity computer game controller influence the sitting ability of young people with cerebral palsy? Disabil Rehabil Assist Technol. 2012 Mar;7(2):122-9.http://www.ncbi.nlm.nih.gov/pubmed/21967300?tool=bestpractice.com
经颅磁刺激
此刺激方法,通过感应线圈调节神经回路的运动皮层。 主要用于映射的大脑回路,但也应用于卒中患者,现在有兴趣将它应用于脑瘫患者。 它被认为是现阶段的探查。[208]Valle AC, Dionisio K, Pitskel NB, et al. Low and high frequency repetitive transcranial magnetic stimulation for the treatment of spasticity. Dev Med Child Neurol. 2007 Jul;49(7):534-8.https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1469-8749.2007.00534.xhttp://www.ncbi.nlm.nih.gov/pubmed/17593127?tool=bestpractice.com[209]Benini R, Shevell MI. Updates in the treatment of spasticity associated with cerebral palsy. Curr Treat Options Neurol. 2012 Dec;14(6):650-9.http://www.ncbi.nlm.nih.gov/pubmed/22851256?tool=bestpractice.com 周围神经磁刺激也被利用,报道称影响运动皮层。影响比实际的治疗时期更长。[210]Flamand VH, Schneider C. Noninvasive and painless magnetic stimulation of nerves improved brain motor function and mobility in a cerebral palsy case. Arch Phys Med Rehabil. 2014 Oct;95(10):1984-90.http://www.ncbi.nlm.nih.gov/pubmed/24907638?tool=bestpractice.com[211]Flamand VH, Beaulieu LD, Nadeau L, et al. Peripheral magnetic stimulation to decrease spasticity in cerebral palsy. Pediatr Neurol. 2012 Nov;47(5):345-8.http://www.ncbi.nlm.nih.gov/pubmed/23044016?tool=bestpractice.com 有证据表明,无论是否进行强制性运动疗法,对偏瘫型脑瘫患儿增加重复经颅磁刺激可增强其治疗诱导性功能性运动改善。[212]Kirton A, Andersen J, Herrero M, et al. Brain stimulation and constraint for perinatal stroke hemiparesis: The PLASTIC CHAMPS Trial. Neurology. 2016 May 3;86(18):1659-67.http://www.ncbi.nlm.nih.gov/pubmed/27029628?tool=bestpractice.com