Spasticity and movement disorders in cerebral palsy

Area of Science:

• Pediatric Neurosurgery
• Neurology
• Movement Disorders

Background:

• Cerebral palsy (CP) is a group of disorders affecting movement and posture, often accompanied by movement disorders.
• Neurosurgical interventions have evolved to address the complex needs of children with CP.

Purpose of the Study:

• To review the historical and current neurosurgical treatments for movement disorders in children with cerebral palsy.
• To assess the efficacy of various neurosurgical modalities over several decades.

Main Methods:

• Comprehensive literature review of neurosurgical treatments for CP-related movement disorders.
• Inclusion of clinical experience spanning three decades in evaluating treatment outcomes.

Main Results:

• Peripheral neurotomies and selective lumbar rhizotomies are effective for focal spasticity and spastic paraparesis.
• Intrathecal baclofen infusions significantly alleviate spasticity in affected extremities and generalized dystonia.
• Deep brain stimulation shows mild improvement for generalized dystonia; intrathecal baclofen is more effective.
• No consistently effective neurosurgical treatment is reported for athetoid CP; deep brain stimulation may benefit choreiform CP.

Conclusions:

• Neurosurgical treatment for pediatric CP movement disorders accelerated in the 1990s with advancements like dorsal rhizotomies and intrathecal baclofen.
• Tens of thousands of children have been treated, integrating these therapies into standard pediatric neurosurgical practice.