Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners London, UK.
Curr Opin Pediatr. 2017 Dec;29(6):652-664. doi: 10.1097/MOP.0000000000000555.
In childhood, movement disorders are generated by a very large number of disorders of the nervous system, and the very different developmental ages at which these occur make studies of pharmacotherapy efficacy extremely difficult. In most clinical practices, medication used in management is by trial and error, and limited by lack of efficacy and/or adverse drug reactions leading to drug intolerance. Nevertheless, symptom reduction using polypharmacy must be balanced against any accompanying comorbidities such as poor attention and concentration, constipation, ileus, urinary retention, blurred vision sedation and respiratory depression.
A 'personalised medicine' approach may lead to specific management breakthroughs that are beneficial to a wider number of children. At present, neuromodulation with implantable devices offers greater proven efficacy for dystonia, myoclonus and dystonic-choreoathetosis, but enteral, intravenous and, more recently, transdermal medication strategies with clonidine patches and enteral gabapentin may provide important relief for both home management and critical care settings.
The current review brings the clinician up-to-date with the latest, albeit limited, thinking on the pharmacological management of movement disorders in children by focussing on goal-directed outcome measures to improve clinical decision-making in an evidence-light clinical setting.
在儿童期，运动障碍由大量神经系统疾病引起，而这些疾病发生的发育年龄差异很大，这使得药物治疗效果的研究变得极其困难。在大多数临床实践中，管理中使用的药物是通过试错法，并且受到疗效有限和/或不良反应导致药物不耐受的限制。然而，必须权衡使用多种药物治疗来减轻症状与任何伴随的共病，如注意力和注意力不集中、便秘、肠梗阻、尿潴留、视力模糊、镇静和呼吸抑制。
“个性化医学”方法可能会带来特定的管理突破，使更多的儿童受益。目前，植入式设备的神经调节为肌张力障碍、肌阵挛和肌张力障碍-舞蹈手足徐动症提供了更大的疗效证明，但肠内、静脉内，以及最近的经皮药物策略，使用可乐定贴片和肠内加巴喷丁，可能为家庭管理和重症监护环境提供重要的缓解。
本综述通过关注目标导向的结果测量，使临床医生了解儿童运动障碍药物治疗的最新但有限的思维，以改善在证据不足的临床环境中的临床决策，从而使临床医生跟上最新进展。
