15
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Neurosurgical Management of Childhood Spasticity: Functional Posterior Rhizotomy and Intrathecal Baclofen Infusion Therapy

      review-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          A paradigm shift is currently ongoing in the treatment of spasticity in childhood in Japan. Functional posterior rhizotomy (FPR), which was first introduced to Japan in 1996, is best indicated for children with spastic cerebral palsy, regardless of the clinical severity of spasticity. Surgery is generally carried out in the cauda equina, where the posterior root is separated from the anterior one, and neurophysiological procedures are used to judge which nerve root/rootlet should be cut. The outcome of FPR is favorable for reducing spasticity in the long-term follow-up. Intrathecal baclofen (ITB) treatment for childhood spasticity was approved in 2007 in Japan and the number of children undergoing ITB pump implantation has been gradually increasing. ITB treatment is best indicated for children with severe spasticity, especially those with dystonia, regardless of the pathological background. Since it is a surgery performed to implant foreign bodies, special attention should be paid to avoid perioperative complications such as CSF leakage, meningitis, and mechanical failure. Severely disabled children with spasticity would benefit most from ITB treatment. We would especially like to emphasize the importance of a strategic approach to the treatment of childhood spasticity. The first step is to reduce spasticity by FPR, ITB, and botulinum toxin injection. The second step is to aim for functional improvement after controlling spasticity. Traditional orthopedic surgery and neuro-rehabilitation form the second step of treatment. The combination of these treatments that allows them to complement each other is the key to a successful treatment of childhood spasticity.

          Related collections

          Most cited references71

          • Record: found
          • Abstract: not found
          • Article: not found

          PRELIMINARY TRIAL OF CARISOPRODOL IN MULTIPLE SCLEROSIS.

          B ASHWORTH (1964)
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Classification and Definition of Disorders Causing Hypertonia in Childhood

            This report describes the consensus outcome of an interdisciplinary workshop that was held at the National Institutes of Health in April 2001. The purpose of the workshop and this article are to define the terms "spasticity," "dystonia," and "rigidity" as they are used to describe clinical features of hypertonia in children. The definitions presented here are designed to allow differentiation of clinical features even when more than 1 is present simultaneously.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              The gross motor function measure: a means to evaluate the effects of physical therapy.

              This paper reports the results of a study to validate a measure of gross motor function in detecting change in the motor function of disabled children. Physiotherapists used this instrument to assess 111 patients with cerebral palsy, 25 with head injury and 34 non-disabled preschool children on two occasions, the second after an interval of four to six months. Parents and therapists independently rated the children's function within two weeks of each assessment, and a sample of paired assessments was videotaped for 'blind' evaluation by therapists. Correlations between scores for change on this measure and the judgments of change by parents, therapists and 'blind' evaluators supported the hypothesis that the instrument would be responsive to both negative and positive changes.
                Bookmark

                Author and article information

                Journal
                Neurol Med Chir (Tokyo)
                Neurol. Med. Chir. (Tokyo)
                NMC
                Neurologia medico-chirurgica
                The Japan Neurosurgical Society
                0470-8105
                1349-8029
                August 2015
                31 July 2015
                : 55
                : 8
                : 624-639
                Affiliations
                [1 ]Division of Neurosurgery, Tokyo Metropolitan Children’s Medical Center, Tokyo;
                [2 ]Division of Neurosurgery, National Medical Center for Children and Mothers, National Center for Child Health and Development, Tokyo
                Author notes

                Conflicts of Interest Disclosure

                The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices used in the article. All authors who are members of The Japan Neurosurgical Society (JNS) have registered online Self-reported COI Disclosure Statement Forms through the website for JNS members.

                Address reprint requests to: Nobuhito Morota, MD, Division of Neurosurgery, Tokyo Metropolitan Children’s Medical Center, 2-8-29 Musashi-dai, Fuchu, Tokyo 183-8561, Japan. e-mail: nobuhito_morota@ 123456tmhp.jp
                Article
                nmc-55-624
                10.2176/nmc.ra.2014-0445
                4628153
                26227057
                c8f709b7-0ff9-453b-a707-76c0f9348ef3
                © 2015 The Japan Neurosurgical Society

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/

                History
                : 24 December 2014
                : 13 March 2015
                Categories
                Review Article

                rhizotomy,baclofen,spasticity,cerebral palsy,surgery
                rhizotomy, baclofen, spasticity, cerebral palsy, surgery

                Comments

                Comment on this article