Skip to main content

Surgical Management of Spasticity

  • Chapter
  • First Online:
Nursing Care of the Pediatric Neurosurgery Patient

Abstract

Spasticity is the result of increased muscle tone, and there are many causes. Nurses that care for patients who have spasticity will find the detailed pathophysiology, excellent clinical examples, and evidence-based treatment modalities very helpful. There are two interesting patient examples, demonstrating opposite views on the challenges parents go through in trying to decide what is best for their children.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 159.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Abbott R (1999) Selective dorsal rhizotomy. http://cerebnet.netfirms.com/selective.htm. Retrieved 16 Aug 2005

  • Adams M, Hicks AL (2010) Spasticity; pathophysiology, assessment, and management. In: Lin VW (ed) Spinal cord medicine: principles and practice. Demos Medical Publishing, New York

    Google Scholar 

  • Albright AL, Ferson SS (2006) Intrathecal baclofen therapy in children. Neurosurg Focus 21(2):1–6

    Article  Google Scholar 

  • Atiyeh BS, Hayek SN, Skaf GS, Araj AA, Chamoun RB (2006) Baclofen pump pocket infection: a case report of successful salvage with muscle flap. Int Wound J 3:23–28

    Article  PubMed  Google Scholar 

  • Awaad Y, Tayem H, Munoz S, Ham S, Michon AM, Awaad R (2003) Functional assessment following intrathecal baclofen therapy in children with spastic cerebral palsy. J Child Neurol 18:26–34

    Article  PubMed  Google Scholar 

  • Bergenheim AT, Wendelius M, Shahidi S, Larsson E (2003) Spasticity in a child with myelomeningocele treated with continuous intrathecal Baclofen. Pediatr Neurosurg 39:218–221. doi:10.1159/000072476

    Article  PubMed  Google Scholar 

  • Boviatsis EJ, Kouyialis AT, Boutsikakis I, Korfas S, Sakas DE (2004) Infected CNS infusion pumps: is there a chance for treatment without removal? Acta Neurochir 146:463–467

    Article  PubMed  CAS  Google Scholar 

  • Center for Disease Control and Prevention, (1999) Guideline for prevention of surgical site infection. Infect Control Hosp Epidemiol 20(4):250–278

    Article  Google Scholar 

  • Cheek WR (1996) Atlas of pediatric neurosurgery. W.B. Saunders Company, Philadelphia

    Google Scholar 

  • Dario A, Tomei G (2004) A benefit-risk assessment of baclofen in severe spinal spasticity. Drug Saf 27(11):799–818

    Article  PubMed  CAS  Google Scholar 

  • Dario A, Scamoni C, Picano M, Fortini G, Cuffari A, Tomei G (2005) The infection risk of intrathecal drug infusion pumps after multiple refill procedures. Neuromodulation 8(1):36–39

    Article  PubMed  Google Scholar 

  • Dawes WJ, Drake JM, Fehlings D (2003) Microfracture of a baclofen pump catheter with intermittent under- and overdose. Pediatr Neurosurg 39(3):144–148

    Article  PubMed  Google Scholar 

  • Dietz V (2000) Spastic movement disorder. Spinal Cord 38:389–393

    Article  PubMed  CAS  Google Scholar 

  • Douglas AF, Weiner HL, Schwartz DR (2005) Prolonged intrathecal baclofen withdrawal syndrome. J Neurosurg 102:1133–1136

    Article  PubMed  Google Scholar 

  • Fitzgerald JJ, Tsegaye M, Vloeberghs MH (2004) Treatment of childhood spasticity of cerebral origin with intrathecal baclofen: a series of 52 cases. Br J Neurosurg 18(3):240–245

    Article  PubMed  CAS  Google Scholar 

  • Follett KA, Burchiel K, Deer T, Dupen S, Prager J, Turner MS et al (2003) Prevention of intrathecal drug delivery catheter-related complications. Neuromodulation 6(1):32–41

    Article  PubMed  Google Scholar 

  • Gallichio JE (2004) Pharmacologic management of spasticity following stroke. Phys Ther 84(10):973–981

    PubMed  Google Scholar 

  • Goldstein EM (2001) Spasticity management: an overview. J Child Neurol 16(1):16–23

    Article  PubMed  CAS  Google Scholar 

  • Gooch JL, Oberg WA, Grams B, Ward LA, Walker ML (2003) Complications of intrathecal baclofen pumps in children. Pediatr Neurosurg 39:1–6

    Article  PubMed  Google Scholar 

  • Grunt S, Becher JG, Vermeulen RJ (2011) Long-term ­outcome and adverse effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review. Dev Med Child Neurol 53:490–498. doi:10.1111/j.469-8749.2011.03912.x

    Article  PubMed  Google Scholar 

  • Guettard E, Roze E, Abada G, Lemesle C, Vidailhet M, Laurent-Vannier A et al (2009) Management of spasticity and dystonia in children with acquired brain injury with rehabilitation and botulinum toxin A. Dev Neurorehabil 12(3):128–138. doi:10.1080/17518420902927994

    Article  PubMed  Google Scholar 

  • Hesselgard K, Reinstrup P, Stromblad LG, Unden J, Romner B (2005) Selective dorsal rhizotomy and postoperative pain management. Pediatr Neurosurg 43:107–112. doi:10.1159/000098382

    Article  Google Scholar 

  • Institute for Neurology and Neurosurgery (2004) Rhizotomy. http://nyneruosurgery.org/cp/thizhist.html. Retrieved 16 Aug 2005

  • Keenan E (2010) Spasticity management, part 3: surgery and the use of intrathecal baclofen. Br J Neurosci Nurs 6(1):12–18

    Google Scholar 

  • Koman LA, Smith B, Balkrishnan R (2003) Spasticity associated with cerebral palsy in children. Paediatr Drugs 5(1):11–23

    PubMed  Google Scholar 

  • Krach LE (2001) Pharmacotherapy of spasticity: oral medications and intrathecal baclofen. J Child Neurol 16(1):31–36

    Article  PubMed  CAS  Google Scholar 

  • Krach LE, Kriel R, Day SM, Strauss DJ (2010) Survival of individual with cerebral palsy receiving continuous intrathecal baclofen treatment: a matched-cohort study. Dev Med Child Neurol 52:672–676. doi:10.1111/j.1469-8749.2009.03473.x

    Article  PubMed  Google Scholar 

  • MacWilliam BA, Johnson BA, Shuckra AL, D’Astous JL (2011) Functional decline in children undergoing selective dorsal rhizotomy after age 10. Dev Med Child Neurol 53:717–723. doi:10.1111/j.1469-8749.2011.04010.x

    Article  Google Scholar 

  • Mohammed I, Hussain A (2004) Intrathecal baclofen withdrwal sysndrome – a life-threatening complication of baclofen pump: a case report. BMC Clin Pharmacol 4(6):1–5. doi:10.1186/1472-6904-4-6

    Google Scholar 

  • Morton RE, Gray N, Vloeberghs M (2011) Controlled study of the effects of continuous intrathecal baclofen infusion in non-ambulant children with cerebral palsy. Dev Med Child Neurol 53:736–741. doi:10.1111/j1469-8749.2011.04009.x

    Article  PubMed  Google Scholar 

  • Moss SD, Manwaring KH (1992) Relief of spasticity for children with cerebral palsy using selective posterior rhizotomy. Phoenix Child Hosp Pediatr Rev 4(1):5–11

    Google Scholar 

  • Motta F, Buonaguro V, Stignani C (2007) The use of intrathecal baclofen pump implants in children and adolescents: safety and complications in 200 consecutive cases. J Neurosurg 107:32–35. doi:10.3171/PED-07/07/032

    PubMed  Google Scholar 

  • Mullarkey T (2009) Considerations in the treatment of spasticity with intrathecal baclofen. Am J Health Syst Pharm 66(Suppl 5):s14–s22. doi:10.2146/ajhp0108c

    Article  PubMed  CAS  Google Scholar 

  • O’Donnell M, Armstrong R (1997) Pharmacologic interventions for management of spasticity in cerebral palsy. Ment Retard Dev Disabil Res Rev 3:204–211

    Article  Google Scholar 

  • Ou C, Kent S, Miller S, Steinbok P (2010) Selective dorsal rhizotomy in children: comparison of outcomes after single-level versus multi-level laminectomy technique. Can J Neurosci Nurs 32(3):17–24

    PubMed  Google Scholar 

  • Plassat R, Verbe BP, Menei P, Menegalli D, Mathe JF, Richard I (2004) Treatment of spasticity with intrathecal baclofen administration: long-term follow-up, review of 40 patients. Spinal Cord 42:686–693

    Article  PubMed  CAS  Google Scholar 

  • Priori A, Cogiamanian F, Mrakic-Sposta S (2006) Pathophysiology of spasticity. Neurol Sci Supp 4(27):s307–s309. doi:10.1007/s10072-006-0647-2

    Article  Google Scholar 

  • Ramstad K, Jahnsen R, Lofterod B, Skjeldal OH (2010) Continuous intrathecal baclofen therapy in children with cerebral palsy – when does improvement emerge? Acta Paediatr 99:1661–1665. doi:10.1111/j.1651-2227.2009.01596x

    Article  PubMed  CAS  Google Scholar 

  • Ridley B, Rawlins PK (2006) Intrathecal baclofen therapy: ten steps toward best practice. J Neurosci Nurs 38(2):72–82

    Article  PubMed  Google Scholar 

  • Rizzo MA, Hadjimichael OC, Preinigherova J, Vollmer TL (2004) Prevalence and treatment of spasticity reported by multiple sclerosis patients. Mult Scler 10:589–595

    Article  PubMed  CAS  Google Scholar 

  • Roscigno CI (2002) Addressing spasticity-related pain in children with spastic cerebral palsy. J Neurosci Nurs 34(3):123–133

    Article  PubMed  Google Scholar 

  • Satkunam LE (2003) Rehabilitation medicine: 3. Management of adult spasticity. CMAJ 169(11):1173–1179

    PubMed  Google Scholar 

  • Sheean G (2002) The pathophysiology of spasticity. Eur J Neurol 9(Suppl 1):3–9

    Article  PubMed  Google Scholar 

  • Stallings VA, Cronk CE, Zemel BS, Charney EB (1995) Body composition in children with spastic quadriplegic cerebral palsy. J Pediatr 126:833–839

    Article  PubMed  CAS  Google Scholar 

  • Steinbok P (2006) Selection of treatment modalities in children with spastic cerebral palsy. Neurosurg Focus 21(2):1–8. doi:10.317/foc.2006.21.2.5

    Article  Google Scholar 

  • Thompson AJ, Jarrett L, Lockley L, Marsden J, Stevenson VL (2005) Clinical management of spasticity. J Neurol Neurosurg Psychiatry 76:459–463. doi:10.1136/jnnp.2004.035972

    Article  PubMed  CAS  Google Scholar 

  • Tedroff K, Lowing K, Jacobson DN, Astrom E (2011) Does loss of spasticity matter? A 10-year follow-up after selective dorsal rhizotomy in cerebral palsy. Dev Med Child Neurol 53(8):724–729. doi:10.1111/j1469-8749.2011.03909x Epud 18 May 2011

    Article  PubMed  CAS  Google Scholar 

  • Vanek ZF, Menkes JH, Carcione J, Talavera F, Lopate G, Benbadis S, Berman SA (2010) Spasticity. eMedicine Neurol. http://www.emedicine.com/neuro/topic706.htm. Retrieved 21 Jan 2004

  • Vender LR, Hester S, Rekito A, Lee MR (2005) Baclofen intrathecal pump delivery systems, avoidance and management of complications in adult and pediatric patients: part 2. Contemp Neurosurg 27(2):1–5

    Google Scholar 

  • Vitztum C, Olney B (2000) Intrathecal baclofen therapy and the child with cerebral palsy. Orthop Nurs 19(1):43–48

    Article  PubMed  CAS  Google Scholar 

  • Von Koch CS, Park TS, Steinbok P, Smyth M, Peacock WJ (2001) Selective posterior rhizotomy and intrathecal baclofen for the treatment of spasticity. Pediatr Neurosurg 35:57–65

    Article  Google Scholar 

  • Ward AB, Molenaers G, Colosimo C, Berardelli A (2006) Clinical value of botulinum toxin in neurological indications. Eur J Neurol 13(Suppl 4):20–26

    Article  PubMed  Google Scholar 

  • Ward A, Hayden S, Dexter M, Scheinberg A (2009) Continuous intrathecal baclofen for children with spasticity and/or dystonia: goal attainment and complications associated with treatment. J Paediatr Child Health 45:720–726. doi:10.1111/j.1440-1754.2009.01601.x

    Article  PubMed  Google Scholar 

  • Wong V (2003) Evidence-based approach of the use of botulinum toxin type A (BTX) in cerebral palsy. Pediatr Rehabil 6(2):85–96. doi:10.1080/1363849031000139306

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Herta Yu RN, MN,CNN©, NP-Paeds .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Yu, H. (2013). Surgical Management of Spasticity. In: Cartwright, C., Wallace, D. (eds) Nursing Care of the Pediatric Neurosurgery Patient. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-32554-0_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-32554-0_11

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-32553-3

  • Online ISBN: 978-3-642-32554-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics