EXCESSIVE CRYING IN CHILDREN WITH CEREBRAL PALSY AND COMMUNICATION DEFICITS

Abstract

Introduction: Pain/discomfort is an under-suspected/underdiagnosed cause of Excessive Crying in Children with Cerebral Palsy and Communication Decits [ECCCPCD] (due to their age or different ability). A vicious cycle of spasm-pain-spasm sets in due to the delay in treatment. To study epidemiology, theObjectives: response of ECCCPCD to drug therapy and a drug taper after 250 days. This was a xed-sequence crossover study ofMethods: 131 consecutive subjects <15 years with>7.5 hours crying duration/day for 30 straight days. Outcome measures: 1. Epidemiological data. 2. Means of total and unexplained cry durations (TECCCPCCD and UECCCPCD) in hours while on the placebo (M1) and four measurements while on treatment (M2-M5). The effect of drug taper was measured (M4). Results: Wilcoxon test between TECCCPCCD of M1-M2 yielded medians of 9.98 (95% CI 9.73 to 10.16), p<0.0001, and 6.27 (95% CI 6.24- 6.28), p<0.0001; between UECCCPCCD yielded medians of M1-M2, 8.22 (95% CI 8.02-8.39), p<0.0001, and 5.14 (95% CI 5.12 to 5.16), p<0.0001, between TECCCPCCD of M1-M5, yielded medians of 9.98 (95% CI 9.73 to 10.16) and 2.67 (95% CI 2.53 to 2.82), p<0.0001, between UECCCPCCD of M1-M5, yielded medians of 8.22 (95% CI 8.02 to 8.39) and 2.16 (95% CI 2.04 to 2.28), ps<0.0001. The dosage could be tapered after 250 days in 67/131 (51%) participants. Secondary outcomes were improvements in swallowing and drooling in 65.12% (56/86). Treatment of spasticity, dystonia, visceral, and neuropathic painConclusions: reduced crying. The drug requirement was less after 250 days of treatment. Parents/caregivers reported simultaneous improvement in dysphagia/drool.