THE ROLE OF SELECTIVE DORSAL RHIZOTOMY IN cérébral PALSY: CRITICAL EVALUATION OF A PROSPECTIVE CLINICAL SERIES

Abstract

SUMMARY This is a prospective observational study of a consecutive series of 34 children with spastic cérébral palsy treated at a single center. 10 had spastic quadriplegia and 24 had spastic diplegia. AH were followed for at least one year. After selective dorsal rhizotomy (SDR), all children received one month of physical therapy at the center and were prescribed a program of physical therapy in their community. The children were assessed before and one year after SDR and physical therapy, using the Ashworth Scale, deep tendon reflex response, range of motion and the Gross Motor Function Measure. The results show that there is often a decrease in lower‐extremity spasticity and functional improvement after SDR with physical therapy, but that there is considerable variability in outcome. Randomized prospective clinical trials with masked objective outcome measures are needed to determine the efficacy of SDR. RÉSUMÉ Le rôle des radicotomies dorsales séleclives dans l' IMOC:évaluation critique d' une série clinique prospective L'article résume une observation prospective d' une série consécutive de 34 enfants IMOC traites dans un meme centre. 11 y avait 10 cas de tetraplegie spastique et 24 cas de diplégie spastique. Le suivi fut au minimum d' un an. Après radicotomie dorsale sélective (SDR), tous les enfants beneficierent d'un mois de kinesitherapie (PT) au centre et recurent une prescription de PT a domicile. Une evaluation des enfants fut faite avant et un an aprés la SDR et le PT, par l'Schelle d'Ashworth, l'etude des reflexes osteo‐tendineux, l'étendue des mouvements et une mesure de l'efficience motrice globale. Les resultats montrerent qu'il y eut souvent une diminution de la spasticite aux extremites inferieures et une amelioration fonctionnelle apres SDR et PT, mais avec une variabilite considerable du devenir. Des essais cliniques prospectifs et randomises avec mesure du devenir en aveugle, sont souhaitables pour determiner l' efficacite de la SDR. RESUMEN Papel de la rizotomia dorsal selectiva en la pardtisis cerebral. Evaluación de unas series clinicas prospectivas Se trata de un estudio de una prospectiva observacional de unas series conseciftivas de 34 niños con parálisis cérébral espástica (PC) tratados en un unico centro. 10 tenian una cuadriplegia espástica y 24 una diplegia espastica. Todos los casos fueron seguidos por lo menos durante un aflo. Despues de una rizotomia dorsal selectiva (RDS) todos los niños siguieron un mes de fisioterapia (FT) en el centro y se les prescribio un programa de FT en su comunidad. Los niños fueron evaluados antes y un aflo despues de RDS y FT utilizando la cscala Ashworth, respuesta refleja tendinosa, amplitud de movimiento y la Gross Motor Function Measure (medición de la función motora grosera). Los resultados mostraron que habia una disminucion de la espasticidad en las extremidades inferiores y una mejoria funcional despues de RDS y FT, pero que habia una gran variedad en el curso. Son necesarios estudios prospectivos randomizados con mediciones objectivas de cu...

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