ABBREVIATIONSBoNT-A Botulinum toxin type A MAS Modified Ashworth Scale ROM Range of motion SDR Selective dorsal rhizotomy AIM The aim of this study was to evaluate the long-term effects of selective dorsal rhizotomy (SDR) in children with cerebral palsy (CP).METHOD Nineteen children (four females, 15 males; mean age 4y 7mo, SD 1y 7mo) with bilateral spastic CP, were prospectively assessed at baseline and 18 months, 3 years, and 10 years after SDR. Assessments included the Modified Ashworth Scale for spasticity, the Gross Motor Function Measure 88 (GMFM-88) and the Wilson gait scale for ambulation, neurological investigations, and passive joint range of motion assessment. A 10-year retrospective chart review was added for orthopaedic surgery after SDR. RESULTSBaseline muscle tone at the hip, knee, and ankle level displayed a high degree of spasticity that normalized after SDR. After 10 years there was a slight recurrence of spasticity at the knee and ankle. Joint range of motion declined from a maximum at 3 years after SDR to the 10-year follow-up. Median ambulatory status was best 3 years after SDR and then declined. The GMFM-88 score increased from the median baseline value of 51 to 66 (p=0.002) and 76 (p<0.001) at the initial follow-ups. After 10 years there was a decline in gross motor function with a reduction in the GMFM-88 score to 62 (p=0.022). Within 10 years, 16 out of 19 patients had a mean of three orthopaedic surgeries (SD 2.8), soft tissue surgery being the most common. INTERPRETATIONThe spasticity-reducing effect of SDR, although pronounced, did not seem to improve long-term functioning or prevent contractures. This suggests that contracture development in CP is not mediated by spasticity alone.In children with cerebral palsy (CP), spasticity has often been assumed to be the main reason for functional limitations and development of contractures. Accordingly, many treatments are aimed at reducing spasticity. Interventions used to reduce spasticity are injections with botulinum toxin type A (BoNT-A), intrathecal baclofen therapy, oral drugs, orthopaedic surgery, and physiotherapy. 1 Selective dorsal rhizotomy (SDR) is a neurosurgical procedure where afferent excitatory nerve fibres emerging from the proprioceptors in the muscle spindles are cut where they enter the posterior root of the spinal cord, thereby reducing efferent excitation. The aim is to reduce spasticity and improve function. Reduction in spasticity has been shown for up to 5 years after SDR. 2There is conflicting evidence when tone-reducing therapies have been evaluated from a functional perspective, typically using gait or various assessments of gross motor function. 3,4 Thus studies have found moderate functional gains [5][6][7][8][9][10][11] or no positive functional outcomes. [12][13][14][15][16] However, only a subgroup of the studies has analysed in depth the possible correlation between a reduction in spasticity and improved function. Of these studies, only Love et al. 6 investigated this relationship and demonstrated a positive...

Aim To describe health‐related quality of life (HRQoL), pain, fatigue, and other health variables in young adults with cerebral palsy (CP), and to explore associations with the Gross Motor Function Classification System – Expanded and Revised (GMFCS‐ER) and physical activity. Method This was a cross‐sectional study of 61 young adults at a mean age of 21 years 2 months (standard deviation 8mo, range 20–22y) with CP, from a geographically defined area. Data collection included: Short Form 36 version 2 for HRQoL, Brief Pain Inventory – Short Form, Fatigue Severity Scale, level of physical activity, medical history, and physical examination. Results Overall HRQoL equalled that of population norms; however self‐reported physical health was lower in GMFCS‐ER levels III to V compared to GMFCS‐ER levels I to II. Self‐reported mental health was, inversely, lower in GMFCS‐ER levels I to II compared to GMFCS‐ER levels III to V. Pain prevalence was 49%, and pain was present across all GMFCS‐ER levels. Fatigue, as well as sleep problems, had 41% prevalence, with fatigue severity decreasing with increasing level of physical activity. Interpretation General HRQoL in young adults with CP was comparable to population norms. Pain and fatigue are important to address in high motor‐functioning individuals also. Physical activity could be a possible protective factor against fatigue. What this paper adds Health‐related quality of life in young adults with cerebral palsy (CP) was comparable to population norms. Pain, fatigue, and sleep problems occurred at all Gross Motor Function Classification System levels. There is a possible protective effect of physical activity on fatigue.

A representative group of young adults with cerebral palsy were studied in order to learn more about social issues, such as living arrangements, employment and relationship status. It was found that, while some young adults were well-established in occupations and relationships, many remained highly dependent on their parental families and their social situation was reduced compared with their peers. Furthermore, lowfunctioning communication level and intellectual disability were the 2 most important risk factors for having a sub-optimal social situation. This suggests that priority should be given to interventions aimed at alleviating the impact of these particular risk factors. Objectives: To describe social outcomes for young adults with cerebral palsy, and to explore associations of social outcomes with their classification levels within the Gross Motor Function, Manual Ability and Communication Function Classification Systems, and with the presence of intellectual disability. Design: A cross-sectional study with a populationbased inclusion approach at a neuropaediatric referral centre in Sweden. Subjects: Sixty-one young adults with cerebral palsy, age 20-22 years. Methods: Physical examination and questionnaires on social outcomes including living arrangements, relationships, occupation, personal finances, extent of family support with personal care. Results: Twenty percent of the young adults with cerebral palsy had moved out of the parental home. Forty-three percent were dependent on family support for basic activities of daily living. Seventy-nine percent of those without intellectual disability were employed or studying. The Communication Function Classification Systems, and presence of intellectual disability, demonstrated associations with most social outcomes, followed in significance by Manual Ability Classification System. Conclusion: In this study young adults with cerebral palsy to a high extent lived in the parental home, and more often without employment, compared with their peers. Many were dependent on parental support, financially, and with activities of daily living. Intellectual disability and communication function were important determinants of social participation. Interventions aimed at alleviating the impact of these particular disabilities should be prioritized.

Objective: To test if botulinum toxin-A (BoNT-A) is effective in reducing chronic muscle-related pain in adults with spastic cerebral palsy (CP), as compared to placebo.Design: A single-center, double-blind, parallel, randomized placebo-controlled trial. The design included an interim analysis to allow for confirmatory analysis, as well as pilot study outcomes.Setting: Tertiary university hospital.Participants: Adults with spastic CP and chronic pain associated with spastic muscle(s).Intervention: Treatment was one session of electromyographically guided intramuscular injections of either BoNT-A or placebo normosaline.Main Study Outcomes: The primary outcome was the proportion who achieved a reduction of pain intensity of two or more steps on the Numerical Rating Scale 6 weeks after treatment.Results: Fifty individuals were screened for eligibility, of whom 16 were included (10 female, 6 male, mean age = 32 years, SD = 13.3 years). The randomization yielded eight participants per treatment arm, and all completed the study as randomized. The study was stopped at the interim analysis due to a low probability, under a preset threshold, of a positive primary outcome. Four individuals were treatment responders in the BoNT-A group for the primary outcome compared to five responders in the placebo group (p = 1.000). Adverse events were mild to moderate. In exploratory analysis, the BoNT-A group had a trend of continuing reduction of pain at the last follow-up, after the primary endpoint.Conclusions: This study did not find evidence that BoNT-A was superior to placebo at the desired effect size (number needed to treat of 2.5) at 6 weeks after treatment.Trial registration:ClinicalTrials.gov: NCT02434549

Background: This study aims to evaluate if children with temporal arachnoid cysts (AC) have cognitive symptoms and if neurosurgery improves these. Methods: A prospective case series study including consecutive pediatric patients with temporal AC. The children underwent neuroradiology, neuroopthalmologic evaluation, and a standard electroencephalography (EEG). Additionally, a neuropsychologist performed a standardized set of evaluations, with a one-year follow-up consisting of Weschler Intelligence Scale for Children version IV (WISC-IV), FAS (for verbal fluency), Boston Naming Test (BNT, for visual naming ability) and NEPSY-II (Developmental NEuroPSYchological Assessment) for verbal memory. Results: Fifteen children, 9 boys and 6 girls, were evaluated and 11 underwent surgery. The Full Scale IQ subscore (FSIQ) improved from M = 84.8 to M = 93.0 (p = 0.005). The preoperative Verbal Comprehension Index (VCI) was in the low average range (M = 86.7), improving to a level within the average range (M = 94.7, p = 0.001). Preoperative Perceptual Speed Index (PSI) was in the below average range (M = 81.5), improving to a level within the average range (M = 92.5, p = 0.004). Conclusion: ACs are a common finding in a pediatric neurosurgical setting. Our data suggest that some temporal AC have a negative effect on general cognitive ability and that this impairment can be improved by surgery. We suggest a standardized evaluation, including comprehensive and validated neuropsychological assessment tools, to thoroughly assess symptoms as well as the postoperative outcome.