Selective dorsal rhizotomy in ambulant children with cerebral palsy

Wang, K. K.; Munger, Meghan E.; Chen, Brian Po-Jung; Novacheck, Tom F.

doi:10.1302/1863-2548.12.180123

Cited by 29 publications

(28 citation statements)

References 64 publications

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“…Prior research on the impact of SDR on energy consumption has also reported reductions in energy, but compared to a control group of TD peers or no control group (Carraro et al, 2014;Nicolini-Panisson et al, 2018;Wang et al, 2018). For example, Trost and colleagues (2008) reported a 22% reduction in energetic cost after SDR (Trost et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

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Spasticity reduction in children with cerebral palsy is not associated with reduced energy consumption during walking

Steele

et al. 2019

Preprint

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Word Count: 246 (250) Main Text Word Count: 2311 (4000) Declarations of interest: none Highlights • Energy consumption is not reduced after rhizotomy compared to matched peers • Spasticity has minimal contribution to elevated energy during walking • Matched control groups are critical in cerebral palsy research AbstractBackground: The average energy consumption during walking of children with cerebral palsy (CP) is over two times of that of typically developing (TD) children and fatigue is one of the top complaints of children with CP and their families. Spasticity has been theorized to contribute to increased energy consumption during walking in CP, but its role remains unclear.Methods: We retrospectively compared the energy consumption of walking in children with diplegic CP before and after selective dorsal rhizotomy (SDR), a surgery that reduces spasticity. A control group of participants with CP who also underwent gait analysis but did not undergo SDR was matched to the SDR group by pre-surgery age, spasticity, and energy consumption. Energy consumption and spasticity were compared at baseline and follow-up for both groups.Findings: As expected, the SDR group has a significantly greater decrease (-44%) in spasticity compared to matched peers with CP who did not undergo SDR (-16%, P<0.001). While both groups had a reduction in energy consumption between visits (12 % SDR and 14% no-SDR), there was no difference in the change in energy consumption between groups (P=0.4).Interpretation: Reducing spasticity did not contribute to greater reductions in energy consumption, suggesting that spasticity has minimal impact on elevated energy consumption during walking for children with CP. Energy consumption and spasticity decrease with age among children with CP. Identifying matched control groups of peers with CP is critical for research involving children with CP to account for changes due to development.

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Section: Discussionmentioning

confidence: 99%

“…Selective dorsal rhizotomy (SDR) is a neurosurgical procedure where afferent nerve fibers in dorsal rootlets are cut to reduce efferent excitations (Tedroff et al, 2011). SDR has been shown to significantly reduce spasticity (Wang et al, 2018). Prior outcome studies have also suggested that SDR reduces energy consumption.…”

Section: Introductionmentioning

confidence: 99%

Spasticity reduction in children with cerebral palsy is not associated with reduced energy consumption during walking

Steele

et al. 2019

Preprint

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“…• continuous intrathecal infusion of baclofen through a pump • selective dorsal rhizotomy: cutting of 50-75% of the dorsal (afferent) nerve fibres on L1-S1 level; this treatment has a permanent and irreversible effect, reducing spasticity solely in the lower limbs • selective peripheral neurotomy: cutting some of the fibres of the peripheral nerve innervating a particular muscle/group of muscles; it only affects the spasticity of the muscle innervated by the cut nerve fibres. [87][88][89] Additional problems in cerebral palsy, such as gastroesophageal reflux, nutrition disorders, and constipation, require the use of specialist therapy methods, which are frequently surgical treatments. Most recently, the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) published guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with neurological impairment.…”

Section: Treatment Of Motor Disorders In Cpmentioning

confidence: 99%

<p>Cerebral Palsy: Current Opinions on Definition, Epidemiology, Risk Factors, Classification and Treatment Options</p>

Sadowska¹,

Sarecka-Hujar

Kopyta

2020

NDT

315

197

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Cerebral palsy (CP) is one of the most frequent causes of motor disability in children. According to the up-to-date definition, CP is a group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to non-progressive disturbances that occurred in the developing foetal or infant brain. The CP definition has evolved over time; the problem is aetiologically and clinically very heterogeneous. According to European data, the average frequency of CP is 2.08 per 1000 live births, but in the group of children born with a body weight below 1500 g, the frequency is 70 times higher when compared with the group of children with a body weight over 2500 g at birth. The risk factors for CP can be divided into preconception, prenatal, perinatal and postnatal ones. CP commonly co-exists with epilepsy, in particular drug-resistant epilepsy, but also with mental retardation, visual and hearing impairment, as well as feeding and behavioral disorders. The degree of motor problem varies from mild to very severe making the child totally dependent on caregivers. Cerebral palsy is divided into forms depending on the type of motor disorders which dominate the clinical presentation; the traditional classifications by Ingram and Hagberg have now been replaced by the Surveillance of Cerebral Palsy in Europe classification which divides CP into spastic, dyskinetic and ataxic forms. Although cerebral palsy is a clinical diagnosis, modern diagnostic imaging provides information that allows the division of the results of magnetic resonance imaging in children with cerebral palsy into five groups according to the magnetic resonance imaging classification system. Just as the clinical presentation and the factors predisposing for CP are very diverse, treatment is also a very complex problem. Modern treatment of spasticity includes both botulinum toxin therapies and surgical techniques, eg, rhizotomy. The authors present current views on definitions, risk factors, diagnostics and treatment of CP as well as comorbid problems, eg, drug-resistant epilepsy.

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“…2,3 However, the indications have been stretched to many different patient populations including those with dystonia and dyskinesia, including non-ambulatory patients. When the appropriate patients with the appropriate indications are chosen, there have been positive results in terms of patient reported outcomes and improvement in function.…”

mentioning

confidence: 99%

“…When the appropriate patients with the appropriate indications are chosen, there have been positive results in terms of patient reported outcomes and improvement in function. 2,3 However, the indications have been stretched to many different patient populations including those with dystonia and dyskinesia, including non-ambulatory patients. 4 One of the post-SDR complications is weakness with increased pelvic tilt and Trendelenburg gait.…”

mentioning

confidence: 99%