Percutaneous radiofrequency lesions adjacent to the dorsal root ganglion alleviate spasticity and pain in children with cerebral palsy: pilot study in 17 patients

Abstract

BackgroundCerebral palsy (CP) may cause severe spasticity, requiring neurosurgical procedures. The most common neurosurgical procedures are continuous infusion of intrathecal baclofen and selective dorsal rhizotomy. Both are invasive and complex procedures. We hypothesized that a percutaneous radiofrequency lesion of the dorsal root ganglion (RF-DRG) could be a simple and safe alternative treatment. We undertook a pilot study to test this hypothesis.MethodsWe performed an RF-DRG procedure in 17 consecutive CP patients with severe hip flexor/adductor spasms accompanied by pain or care-giving difficulties. Six children were systematically evaluated at baseline, and 1 month and 6 months after treatment by means of the Modified Ashworth Scale (MAS), Gross Motor Function Measure (GMFM) and a self-made caregiver's questionnaire. Eleven subsequent children were evaluated using a Visual Analogue Scale (VAS) for spasticity, pain and ease of care.ResultsA total of 19 RF-DRG treatments were performed in 17 patients. We found a small improvement in muscle tone measured by MAS, but no effect on the GMFM scale. Despite this, the caregivers of these six treated children unanimously stated that the quality of life of their children had indeed improved after the RF-DRG. In the subsequent 11 children we found improvements in all VAS scores, in a range comparable to the conventional treatment options.ConclusionRF-DRG is a promising new treatment option for severe spasticity in CP patients, and its definitive effectiveness remains to be defined in a randomised controlled trial.

Pulsed Radiofrequency of Dorsal Root Ganglia for the Treatment of Complex Regional Pain Syndrome in an Adolescent with Poliomyelitis Sequel: A Case Report

“…The dorsal roots are intact in patients with poliomyelitis, and sensory stimulation tests were applied successfully in our case. The locations of the DRG can only be confirmed via the administration of contrast material in pediatric patients . The exact location of the DRGs was confirmed using the sensory stimulations test and the administration of contrast material in the present case (Figure ).…”

Management of pain in children and adolescents with cerebral palsy: a systematic review

“…Two systematic reviews were included in this category; one reviewed BoNT‐A injections and the other reviewed pharmacological interventions (BoNT‐A and ITB) for children with CP and other life‐limiting conditions . Individual studies in these reviews were included if they met the eligibility criteria . Two studies were excluded as an outcome measure of pain was not reported …”

Application of radiofrequency thermocoagulation combined with adriamycin injection in dorsal root ganglia for controlling refractory pain induced by rib metastasis of lung cancer (a STROBE-compliant article)

“…Radiofrequency thermocoagulation on DRG has been widely applied for the treatment of various chronic pains. [ 5 , 6 ] The corresponding area of sensory nerve is not able to regenerate after DRG injury, so the therapeutic effects of radiofrequency thermocoagulation are exact and constant. Radiofrequency thermocoagulation has been widely used in the control of pain caused by cancer.…”