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Updated: Jun 19, 2026
Repeated Transcranial Magnetic Stimulation Combined with Action Observation Training in Children with Spastic Cerebral Palsy
Published on: August 9, 2024
Preoperative MRI findings and functional outcome after selective dorsal rhizotomy in children with bilateral
Sebastian Grunt1, Jules G Becher, Petra van Schie
1Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Purpose:
To identify MRI characteristics that may predict the functional effect of selective dorsal rhizotomy (SDR) in children with bilateral spastic paresis.
Methods:
We performed SDR in a group of 36 patients. The gross motor functioning measure-66 (GMFM-66) was applied before and after SDR. Available cerebral MRIs were retrospectively classified into three diagnostic groups: periventricular leucomalacia (PVL; n = 10), hydrocephalus (n = 2), and normal (n = 6). In patients with PVL, we scored the severity of the MR abnormalities. We compared the changes in the GMFM-66 after SDR in the diagnostic groups. In patients with PVL, we correlated the severity of the MR abnormalities with the changes in the GMFM-66.
Results:
The mean follow-up period was 5 years and 4 months (range, 1 year and 1 month to 9 years). The best improvement in gross motor function was observed in patients with normal MRI, and the slightest improvement was observed in patients with hydrocephalus. The severity of the PVL did correlate with the GMFM-66 score before SDR but not with the functional effect of SDR.
Conclusion:
We conclude that with respect to gross motor skills, the improvements after SDR are good in patients with no MRI abnormalities. In the patients with hydrocephalus, the improvements after SDR were insignificant. In patients with PVL, the improvements were intermediate and did not correlate with the degree of PVL.
Insights
Selective dorsal rhizotomy (SDR) shows good functional gains in children with normal MRI scans. However, outcomes are less significant for those with hydrocephalus and intermediate for periventricular leucomalacia (PVL) without a clear correlation to PVL severity.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Radiology
Background:
- Bilateral spastic paresis significantly impacts children's gross motor function.
- Selective dorsal rhizotomy (SDR) is a surgical intervention aimed at improving motor function.
- Predicting SDR outcomes is crucial for patient selection and management.
Purpose of the Study:
- To determine if MRI characteristics can predict the functional outcomes of SDR in children with bilateral spastic paresis.
- To correlate specific MRI findings with improvements in gross motor function after SDR.
Main Methods:
- Retrospective analysis of 36 patients undergoing SDR.
- Assessment of gross motor function using the Gross Motor Function Measure-66 (GMFM-66) pre- and post-SDR.
- Classification of cerebral MRIs into periventricular leucomalacia (PVL), hydrocephalus, and normal groups, with severity scoring for PVL.
Main Results:
- Patients with normal MRIs showed the best GMFM-66 improvement post-SDR.
- Patients with hydrocephalus exhibited the least improvement.
- PVL severity correlated with pre-SDR GMFM-66 scores but not with the functional improvement achieved after SDR.
Conclusions:
- SDR yields significant gross motor improvements in children with normal brain MRIs.
- Functional gains from SDR are minimal in patients with hydrocephalus.
- Children with PVL show intermediate improvements after SDR, independent of the lesion's severity.
