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Effects of continuous intrathecal baclofen infusion and selective posterior rhizotomy on upper extremity spasticity
A L Albright1, M J Barry, M P Fasick
1Department of Neurosurgery, Children's Hospital of Pittsburgh, PA 15213, USA.
Insights
Continuous intrathecal baclofen infusion (CIBI) and selective posterior rhizotomy (SPR) both effectively reduce upper extremity spasticity in children with cerebral palsy, with no significant impact on range of motion.
Area of Science:
- Neurology
- Pediatric Orthopedics
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) often causes upper extremity (UE) spasticity, impacting function.
- Current treatments for CP spasticity include CIBI and SPR, with known benefits for lower extremities.
Purpose of the Study:
- To compare the efficacy of CIBI and SPR in reducing UE spasticity in children with CP.
- To assess the impact of these interventions on UE range of motion.
Main Methods:
- A retrospective study comparing 38 children treated with CIBI (≥6 months) to 38 children who underwent SPR.
- Patients were matched based on pre-treatment UE muscle tone and functional status.
- Spasticity assessed using the Ashworth scale; range of motion evaluated at 6 and 12 months.
Main Results:
- Both CIBI and SPR significantly reduced UE spasticity after 1 year (p < 0.01 and p = 0.005, respectively).
- SPR showed a greater likelihood of clinically significant tone reduction in patients with higher initial UE tone.
- No significant changes in UE range of motion were observed for either treatment group.
Conclusions:
- Both CIBI and SPR are effective in reducing UE spasticity in children with cerebral palsy.
- These findings add to the known benefits of CIBI and SPR for lower extremity spasticity.
Abstract:
This study was performed to compare the effects of continuous intrathecal baclofen infusion (CIBI) and selective posterior rhizotomy (SPR) on upper extremity (UE) spasticity and range of motion in children with cerebral palsy. Spasticity was assessed with the Ashworth scale of muscle tone and range of motion was evaluated. Thirty-eight patients who had been treated with CIBI for at least 6 months were paired, according to pretreatment UE muscle tone and functional status, with 38 patients who had undergone SPR. The CIBI dosage had been titrated to reduce over lower extremity spasticity and improve lower extremity function, rather than to improve UE tone. The pretreatment muscle tone in the two groups was virtually identical. The UE tone of children treated with CIBI decreased from 2.07 prior to treatment to 1.66 after 1 year (p < 0.01). The tone of children treated with SPR decreased from 2.03 to 1.70 after 1 year (p = 0.005). In that group, the likelihood of a clinically significant reduction in muscle tone (one point or greater) was greater in children with a higher pretreatment UE muscle tone. There was no correlation between the percentage of posterior lumbar roots divided in SPR and the subsequent reduction in UE tone. There were no significant changes in the range of motion in any UE joint, at either 6 or 12 months, after either CIBI or SPR. We conclude that both CIBI and SPR significantly reduce UE spasticity, in addition to the previously documented reduction in lower extremity spasticity.