Surgical management of spasticity of cerebral origin in children

Abstract

SummaryIn children, spasticity is commonly seen in the context of cerebral palsy (CP), but also following head injury, cerebral infarct or other brain insults. CP is a wide term used to describe a constellation of symptoms that characterise the physical impairment of movement due to abnormal brain development. The management of spasticity is tailored according to the clinical picture of the child. Ambulatory mild spastic diplegics tend to reach the maximum of their disability in the first few years of life, and change little after the age of 5-7 years. Such patients who are seen between 3-5 years and who attempt to mobilise with walking frames are often good candidates for either dorsal rhizotomy or intrathecal baclofen (ITB) administration with the implantation of an indwelling pump. Non-ambulatory mild spastic diplegics and spastic quadriplegics have more profound spasticity, painful spasms, orthopaedic deformities, and difficulties with daily care and posture. ITB has become established as the first line of surgical treatment for these patients. In the last decade, there has been a definite trend away from ablative treatments and towards reversible stimulation and infusion systems. Current pumps have practical limitations but, in the next decade, it is anticipated that technological improvements will render the pumps more patient friendly.

Complications of Intrathecal Baclofen Pumps in Children: Experience from a Tertiary Care Center

“…The possible merits are: (a) the data may be more meaningful due to restriction of the number of variables affecting the results; (b) interventions based on the observation may be easier. The spectrum of cases in our series conforms to other series in children [14,16,23,24,25]. Most had cerebral palsy, the commonest type being spastic quadriplegia (84%).…”

New Clinical and Research Trends in Lower Extremity Management for Ambulatory Children with Cerebral Palsy

“…Other centers advocate for ITB to improve ambulation in patients with CP. In studies with careful selection criteria improved long-term ambulation is supported by the literature (73, 73, 74, 75, 76, 77, 78). …”

Use of intrathecal baclofen therapy in ambulant children and adolescents with spasticity and dystonia of cerebral origin: a systematic review

“…Spasticity is a velocity‐dependent increase in resistance of a muscle when stretched, 1 and is one of the common signs of an upper motor neuron lesion. Spasticity can make movements difficult and inefficient, which in turn contributes to the formation of contractures, discomfort, and muscle spasms, and thus interferes with activities of daily living such as feeding, toileting, dressing, and positioning 2,3 . One of the pharmacological agents used in treating spasticity is baclofen, an agonist of the inhibitory neurotransmitter gamma‐aminobutyric acid (GABA) 4 .…”