Have Cerebral palsy disorder. not sleeping regularly. Suggest treatment?

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Posted on Mon, 21 Oct 2013 in Headache and Migraines
Question: Greetings Dr XXXXXXX

I have a 11 year old son with Cerebral palsy disorder. Recently I got him treated at Apollo, Secunderbad under guidance of Dr XXXXXXX Viswanathi for Aspiration Pnemonia.

My son (Master Srinivas) was born in Bangalore and initially got treatment at Manipal hospital and later at various place and was on physiotherpy for long time, but without much success. But after the pnemonia he had lost some weight because of which his body has become little more flexible.

The major issue what we are facing for last couple of weeks, is that he is not sleeping regularly and keeps crying for which Dr XXXXXXX was consulted about couple of weeks but without any much improvement. Hence would be grateful if you can suggest some treatment. Since I am not aware, how you handle online consultation please let me know the payment process.
Greetings Dr XXXXXXX

I have a 11 year old son with Cerebral palsy disorder. Recently I got him treated at Apollo, Secunderbad under guidance of Dr XXXXXXX Viswanathi for Aspiration Pnemonia.

My son was born in Bangalore and initially got treatment at Manipal hospital and later at various place and was on physiotherpy for long time, but without much success. But after the pnemonia he had lost some weight because of which his body has become little more flexible.

The major issue what we are facing for last couple of weeks, is that he is not sleeping regularly and keeps crying for which Dr XXXXXXX was consulted about couple of weeks but without any much improvement. Hence would be grateful if you can suggest some treatment. Since I am not aware, how you handle online consultation please let me know the payment process.

Thanks and await for your favorable response.


Regards
XXXXX
doctor
Answered by Dr. Sudhir Kumar 2 hours later
Brief Answer:
Simple medications may be helpful.

Detailed Answer:
Hi,

Thank you for posting your query.

I read your description in detail.

I am not sure what medications your son is on at present.

Currently, medications that could help him are low dose diazepam or clonazepam. If your son was my patient in my clinic, I would have started him on tablet diazepam 5 mg or clonazepam 0.5 mg once daily at bedtime. If there was more drowsiness with this dose, then I would give half the dose.

If restlessness is also an issue, then, I would use risperidone.

I hope it helps. Please get back if you have any more queries.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant neurologist
Apollo Hospitals, Jubilee Hills, Hyderabad
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 10 hours later
Dr XXXXXXX

Thanks for your quick response. At present no medication is given to my son, except Sodium Valprin Syrup 7.5 ml thrice. He is also restlessness, hence should start on the following as per your advice.

tablet diazepam 5 mg - at bedtime (if I notice more drowsiness will reduce the dosage by 50%).

What is the dosage for Risperidone?

How long should I continue the above medication and when to get back to you for review.
Thanks
XXXXX

doctor
Answered by Dr. Sudhir Kumar 3 hours later
Brief Answer:
My replies are below

Detailed Answer:
Thank you for getting back.

1. The dose of diazepam is correct, as you have mentioned above.
2. The usual dose for risperidone for a patient that I see in my clinic would be 0.5 mg half tablet at bedtime.

You should continue valparin.
The usual time to review would be after 10-14 days.
I hope it helps.

Please get back if you require any additional information.

Best wishes,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad,
My personal URL on this website: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 23 hours later
Good afternoon,

As per your advice yesterday night gave my son Diazepam 5 mg, 1 tab, and he had good sleep from 10pm to 9am. I could not get the other tab Risperidone, will try to procure today.

In the meanwhile just remembered i forgot to mention in my first mail, that most of the time he keeps his mouth open and there is dryness in his tongue. Padetrician mentioned its lack of Vitamin A, and advised to give Caserol sachets once a week for 5 weeks, which we have done. But still he has dryness in skin and keeps mouth open most of time. There is no option of upload here, otherwise I would have sent his photograph.

Apart from the above he has not issues, eats food properly and has regular motions etc.
doctor
Answered by Dr. Sudhir Kumar 4 hours later
Brief Answer:
Do not start serenace at present

Detailed Answer:
Thank you for getting back.

Since he had a good sleep with diazepam, let us not start serenace at present. We will see the effect of diazepam for about 10 days before deciding whether to add serenace also or not. Adding serenace may make him more sleepy.

There is an option of uploading a photograph, please check with XXXXXXX staff.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 46 hours later
Dear Dr XXXXXXX

As mentioned in my earlier mail, on the first day when we gave Diazepam, around 9pm in night, he slept at 10 pm and woke up next day morning at around 8 am. After on on that day again we gave same time, but he did not sleep whole night till morning 7 am, after which he slept and got up by 6 pm, and again did not sleep till morning 7 am. INFACT LAST 2 NIGHTS HAVE BEEN VERY TOUGH FOR US, AS HE DID NOT SLEEP AND KEPT ON CYRING WHOLE NIGHT, WE HAD TO KEEP ON TAPPING.
He slept today morning at 7 am and got up at 1pm and started crying again. Please let us know what to, do if required we can bring him to your clinic, as we are unable to manage him in the nights.
doctor
Answered by Dr. Sudhir Kumar 5 hours later
Brief Answer:
you can use serenade 0.5 mg at night.

Detailed Answer:
Thank you for getting back.

You can use Serenace in addition to diazepam. An usual initial dose is 0.5 mg.

As I am out of station for a week, you can consult me next week. However, if you wish, you may consult Dr Pranathi Gutta XXXXXXX Pediatric Neurologist, at Apollo Hospitals, Jubilee Hills.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Sudhir Kumar

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Practicing since :1994

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