Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The goal of drug therapy is to reduce the effects of cerebral palsy and prevent complications. Medications are prescribed to reduce spasticity and abnormal movements and to prevent seizures.
Medications used to relieve spasticity and abnormal movements include the following:
Dopaminergic drugs: Widely used in Parkinson's disease, these drugs increase the level of a brain chemical called dopamine. The effect is to decrease rigidity and abnormal movements. Examples include levodopa/carbidopa (Sinemet) and trihexyphenidyl (Artane).
Muscle relaxants: These agents reduce spasticity by relaxing the muscle directly. Examples include baclofen (Lioresal). This drug can be taken as a pill or be administered automatically via an implantable pump.
Benzodiazepines: These agents act on brain chemistry to relax muscles. The most widely used of these agents is diazepam (Valium).
Botulinum toxin type A: This substance is widely known as BOTOX®. When injected, it causes a mild muscle paralysis and reduces contractions. In cerebral palsy, it is used to decrease spasticity of muscles of the arms or legs, which improves range of motion and overall mobility. This can be important in allowing a child to fit into an orthotic (brace or splint) or even to be comfortably positioned in a wheelchair. The effects of BOTOX® injections typically last 3 to 6 months. BOTOX® helps other treatments work better, such as physical therapy or casting the limb. In some cases, using BOTOX® can delay surgery or make surgery unnecessary. Some people have allergic-type reactions to BOTOX® and must limit the number of injections or stop them altogether.
Medications used to relieve seizures include the following:
Anticonvulsants: These agents stop seizure activity as rapidly as possible and prevent seizure recurrence. There are many difference agents available; they vary in their mechanism of action.
Benzodiazepines: Agents such as diazepam often are used to stop seizures when they are frequent or prolonged.
Ketogenic diet: this is a special diet rich in fats that result in the production of excess of ketones which, acting in the brain, can reduce the number of seizures.