Table 5.

Treatment of Manifestations in Individuals with Spastic Paraplegia 15

Manifestation/
Concern		TreatmentConsiderations/Other
Spasticity/
Weakness
  • PT
  • Antispasticity medications (oral or intrathecal baclofen & others)
  • Botulinum toxin injections
  • Surgical treatment
  • Progression of contractures, scoliosis, foot deformities, & loss of ambulation may be delayed w/PT & antispasticity treatment.
  • Consider need for positioning & mobility devices.
  • Monitor skin integrity.
Contractures,
scoliosis, foot
deformities (pes
cavus)
  • PT
  • Referral to orthopedic surgery
Assess need for orthoses/braces & mobility devices.
Cerebellar
dysfunction 		Assess fall risk & home safety.Consider need for positioning & mobility devices.
Parkinsonism Trial of L-dopa
  • Variable response; evidence is limited. 1
  • Assess treatment response w/Unified Parkinson's Disease Rating Scale.
Dystonia
  • Botulinum toxin injections for focal dystonia
  • Anti-dystonia medications
DD/ID,
cognitive
impairment
  • PT, OT
  • Consultation w/social worker
In adults, anticipate & assist w/issues of guardianship that may accompany progressive decline.
Dysarthria /
Speech delay 		Speech therapy by speech & language therapistAssess utility of augmentative communication devices.
Dysphagia/
Aspiration
  • Therapy by speech & language therapist
  • Anticholinergic agents for sialorrhea
  • G-tube feeds
Management by interdisciplinary aerodigestive team
Nutrition Nutritional supplementationReferral to nutritionist
Ophthalmologic
involvement 		Referral to ophthalmologist
Neurogenic
bladder
  • Anticholinergic drugs for urinary urgency
  • Referral to urologist
Bowel
dysfunction,
chronic
constipation,
GER
  • Stool softeners, prokinetics, osmotic agents, or laxatives as needed
  • Proton pump inhibitors, histamine receptor antagonists, or antacids as needed
  • Consideration of fundoplication in refractory cases
Referral to gastroenterologist
Osteopenia Vitamin D & calcium supplementation
Routine
health care 		Standard immunizations per local guidelines
Family &
Community 		Ensure appropriate social work involvement to connect families w/local resources, respite, & support.
  • Coordinate care to manage multiple subspecialty appointments, equipment, medications, & supplies.
  • Ongoing assessment of need for palliative care involvement &/or home nursing.
  • Referral to palliative care when deemed appropriate by family & health care providers

DD/ID = developmental delay / intellectual disability; GER = gastroesophageal reflux; OT = occupational therapy; PT = physical therapy

1.

From: Spastic Paraplegia 15

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