Advertisement

Surgical Management of Spasticity

  • Herta Yu
Chapter

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.

Keywords

Cerebral Palsy Intrathecal Baclofen Selective Dorsal Rhizotomy Increase Muscle Tone Severe Spasticity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Abbott R (1999) Selective dorsal rhizotomy. http://cerebnet.netfirms.com/selective.htm. Retrieved 16 Aug 2005
  2. Adams M, Hicks AL (2010) Spasticity; pathophysiology, assessment, and management. In: Lin VW (ed) Spinal cord medicine: principles and practice. Demos Medical Publishing, New YorkGoogle Scholar
  3. Albright AL, Ferson SS (2006) Intrathecal baclofen therapy in children. Neurosurg Focus 21(2):1–6CrossRefGoogle Scholar
  4. 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 3:23–28PubMedCrossRefGoogle Scholar
  5. 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 18:26–34PubMedCrossRefGoogle Scholar
  6. 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 PubMedCrossRefGoogle Scholar
  7. 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 146:463–467PubMedCrossRefGoogle Scholar
  8. Center for Disease Control and Prevention, (1999) Guideline for prevention of surgical site infection. Infect Control Hosp Epidemiol 20(4):250–278CrossRefGoogle Scholar
  9. Cheek WR (1996) Atlas of pediatric neurosurgery. W.B. Saunders Company, PhiladelphiaGoogle Scholar
  10. Dario A, Tomei G (2004) A benefit-risk assessment of baclofen in severe spinal spasticity. Drug Saf 27(11):799–818PubMedCrossRefGoogle Scholar
  11. 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):36–39PubMedCrossRefGoogle Scholar
  12. Dawes WJ, Drake JM, Fehlings D (2003) Microfracture of a baclofen pump catheter with intermittent under- and overdose. Pediatr Neurosurg 39(3):144–148PubMedCrossRefGoogle Scholar
  13. Dietz V (2000) Spastic movement disorder. Spinal Cord 38:389–393PubMedCrossRefGoogle Scholar
  14. Douglas AF, Weiner HL, Schwartz DR (2005) Prolonged intrathecal baclofen withdrawal syndrome. J Neurosurg 102:1133–1136PubMedCrossRefGoogle Scholar
  15. 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):240–245PubMedCrossRefGoogle Scholar
  16. 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):32–41PubMedCrossRefGoogle Scholar
  17. Gallichio JE (2004) Pharmacologic management of spasticity following stroke. Phys Ther 84(10):973–981PubMedGoogle Scholar
  18. Goldstein EM (2001) Spasticity management: an overview. J Child Neurol 16(1):16–23PubMedCrossRefGoogle Scholar
  19. Gooch JL, Oberg WA, Grams B, Ward LA, Walker ML (2003) Complications of intrathecal baclofen pumps in children. Pediatr Neurosurg 39:1–6PubMedCrossRefGoogle Scholar
  20. 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 PubMedCrossRefGoogle Scholar
  21. 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 PubMedCrossRefGoogle Scholar
  22. 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 CrossRefGoogle Scholar
  23. Institute for Neurology and Neurosurgery (2004) Rhizotomy. http://nyneruosurgery.org/cp/thizhist.html. Retrieved 16 Aug 2005
  24. Keenan E (2010) Spasticity management, part 3: surgery and the use of intrathecal baclofen. Br J Neurosci Nurs 6(1):12–18Google Scholar
  25. Koman LA, Smith B, Balkrishnan R (2003) Spasticity associated with cerebral palsy in children. Paediatr Drugs 5(1):11–23PubMedGoogle Scholar
  26. Krach LE (2001) Pharmacotherapy of spasticity: oral medications and intrathecal baclofen. J Child Neurol 16(1):31–36PubMedCrossRefGoogle Scholar
  27. 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 PubMedCrossRefGoogle Scholar
  28. 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 CrossRefGoogle Scholar
  29. 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
  30. 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 PubMedCrossRefGoogle Scholar
  31. Moss SD, Manwaring KH (1992) Relief of spasticity for children with cerebral palsy using selective posterior rhizotomy. Phoenix Child Hosp Pediatr Rev 4(1):5–11Google Scholar
  32. 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 PubMedGoogle Scholar
  33. 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 PubMedCrossRefGoogle Scholar
  34. O’Donnell M, Armstrong R (1997) Pharmacologic interventions for management of spasticity in cerebral palsy. Ment Retard Dev Disabil Res Rev 3:204–211CrossRefGoogle Scholar
  35. 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):17–24PubMedGoogle Scholar
  36. 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 42:686–693PubMedCrossRefGoogle Scholar
  37. 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 CrossRefGoogle Scholar
  38. 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 PubMedCrossRefGoogle Scholar
  39. Ridley B, Rawlins PK (2006) Intrathecal baclofen therapy: ten steps toward best practice. J Neurosci Nurs 38(2):72–82PubMedCrossRefGoogle Scholar
  40. Rizzo MA, Hadjimichael OC, Preinigherova J, Vollmer TL (2004) Prevalence and treatment of spasticity reported by multiple sclerosis patients. Mult Scler 10:589–595PubMedCrossRefGoogle Scholar
  41. Roscigno CI (2002) Addressing spasticity-related pain in children with spastic cerebral palsy. J Neurosci Nurs 34(3):123–133PubMedCrossRefGoogle Scholar
  42. Satkunam LE (2003) Rehabilitation medicine: 3. Management of adult spasticity. CMAJ 169(11):1173–1179PubMedGoogle Scholar
  43. Sheean G (2002) The pathophysiology of spasticity. Eur J Neurol 9(Suppl 1):3–9PubMedCrossRefGoogle Scholar
  44. Stallings VA, Cronk CE, Zemel BS, Charney EB (1995) Body composition in children with spastic quadriplegic cerebral palsy. J Pediatr 126:833–839PubMedCrossRefGoogle Scholar
  45. 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 CrossRefGoogle Scholar
  46. 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 PubMedCrossRefGoogle Scholar
  47. 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 2011PubMedCrossRefGoogle Scholar
  48. 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
  49. 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):1–5Google Scholar
  50. Vitztum C, Olney B (2000) Intrathecal baclofen therapy and the child with cerebral palsy. Orthop Nurs 19(1):43–48PubMedCrossRefGoogle Scholar
  51. 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 35:57–65CrossRefGoogle Scholar
  52. Ward AB, Molenaers G, Colosimo C, Berardelli A (2006) Clinical value of botulinum toxin in neurological indications. Eur J Neurol 13(Suppl 4):20–26PubMedCrossRefGoogle Scholar
  53. 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 PubMedCrossRefGoogle Scholar
  54. 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 PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of NeurosurgeryHospital for Sick ChildrenTorontoCanada

Personalised recommendations