For children whose spasticity and movement disorders are inadequately treated by oral medications and botulinum toxins, neurosurgical procedures are now available to effectively treat spasticity, tremor, and many cases of dystonia. Spastic diplegia can be treated with selective lumbar rhizotomies, which significantly decrease spasticity, increase range of motion, and improve Gross Motor Function Measure scores. Children with spastic quadriparesis and those with secondary dystonia can be treated with intrathecal baclofen, which diminishes both spasticity and dystonia and is associated with improved function and quality of life. Children with primary dystonia and those with tremor can be treated with deep brain stimulation of the internal globus pallidus and thalamus, respectively. Some children with chorea respond to deep brain stimulation. There are no effective neurosurgical treatments for athetosis or ataxia. The effectiveness of neurosurgical treatments of pediatric movement disorders has increased significantly in the past 15 years. (J Child Neurol 2003;18:S67—S78).
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References
1.
Horsley V.: Remarks on the surgery of the central nervous system. BMJ1890;2:125—132.
2.
Putnam TJ: Results of the treatment of athetosis by section of extrapyramidal motor tracts . Arch Neurol Psychiatry1938 ; 39:258—275.
3.
Foerster O.: On the indications and results of the excision of posterior spinal nerve roots in men. Surg Gynecol Obstet1913 ; 16:463—474.
4.
Fasano VA, Broggi G., Barolat-Romana G., et al: Surgical treatment of spasticity in cerebral palsy. ChildsBrain1978;4:289—305.
5.
DeCandia M., Provvini L., Taborikova H.: Mechanisms of the reflex discharge depression in the spinal motoneurone during repetitive orthodromic stimulation. Brain Res1967;4:284—291.
6.
Peacock WJ, Staudt LA: Functional outcomes following selective posterior rhizotomy in children with cerebral palsy. J Neurosurg1991;74:380—385.
7.
Abbott R.: Sensory rhizotomy for the treatment of childhood spasticity. J Child Neurol1996;11(Suppl 1):S36—S42.
8.
Weiss I., Schiff S.: Reflex variability in selective dorsal rhizotomy. J Neurosurg1993;79:346—353.
9.
Steinbok P., Langill L., Cochrane DD, Keyes R.: Observations on electrical stimulation of lumbosacral nerve roots in children with and without lower limb spasticity. Childs Nerv Syst1992;8:376—382.
10.
Sacco DJ, Tylkowski CM, Warf BC: Nonselective partial dorsal rhizotomy: A clinical experience with a 1-year follow-up. Pediatr Neurosurg2000 ;32:114—118.
11.
McLaughlin J., Bjornson K., Temkin N., et al: Selective dorsal rhizotomy: Meta-analysis of three randomized controlled trials. Dev Med Child Neurol2002;44:17—25.
12.
Beck AJ, Gaskill SJ, Marlin AE, et al: Improvement in upper extremity function and trunk control after selective posterior rhizotomy. Am J Occup Ther1993;47:704—707.
13.
Heim R., Park TS, Vopgler G., et al: Changes in hip migration after selective dorsal rhizotomy for spastic quadriplegia in cerebral palsy. J Neurosurg1995;82:567—571.
14.
Loewen P., Steinbok P., Holsti L., et al: Upper extremity performance and self-care skill changes in children with spastic cerebral palsy following selective posterior rhizotomy. Pediatr Neurosurg1998;29:191—198.
15.
Chicoine MR , Part TS, Kaufman BA: Selective dorsal rhizotomy and rates of orthopedic surgery in children with spastic cerebral palsy. J Neurosurg1997;86:34—39.
16.
Sweetser PM , Badell A., Schneider S., et al:Effects of sacral dorsal rhizotomy on bladder function in patients with spastic cerebral palsy . Neurourol Urodynam1995;14:57—64.
Mittal S., Farmer J-P., Al-Atassi B., et al: Functional performance following posterior rhizotomy: Long-term results determined using a validated evaluative measure. J Neurosurg2002;97:510—518.
19.
Heimburger RF, Slominski A., Griswold P.: Cervical posterior rhizotomy for reducing spasticity in cerebral palsy. J Neurosurg1973;39:30—34.
20.
Bertelli JA , Ghizoni MF, Michels A.: Brachial plexus dorsal rhizotomy in the treatment of upper-limb spasticity. J Neurosurg2000 ;93:26—32.
21.
Knutsson E. , Lindblom U., Martensson A.: Plasma and cerebrospinal fluid levels of baclofen (Lioresal) at optimal therapeutic responses in spastic paresis. J Neurol Sci1974;23:473—484.
22.
Müller H., Zierski J., Dralle D., et al: Pharmacokinetics of intrathecal baclofen, in Muller J, Zierski J, Penn RD (eds): Local-Spinal Therapy of Spasticity . New York, Springer-Verlag, 1988, 223-226.
23.
Kroin JS, Ali A., York M., et al: The distribution of medication along the spinal canal after chronic intrathecal administration. Neurosurgery1993;33:226—230.
24.
Dralle D., Muller H., Zierski J., Klug N.: Intrathecal baclofen for spasticity. Lancet1985;ii:1003.
25.
Zierski J., Müller H., Dralle D., Wurdinger T.: Implanted pump systems for treatment of spasticity. Acta Neurochir Suppl (Wien)1988; S43:94—99.
26.
Albright AL , Cervi A., Singletary J.: Intrathecal baclofen for spasticity in cerebral palsy. JAMA1991 ;265:1418—1422.
27.
Albright AL , Barron WB, Fasick MP, et al: Continuous intrathecal baclofen infusion for spasticity of cerebral origin. JAMA1993 ;270:2475—2477.
28.
Dan B., Cheron G.: Intrathecal baclofen normalizes motor strategy for squatting in familial spastic paraplegia: A case study. Neurophysiol Clin2000;30:43—48.
29.
Albright AL: Baclofen pump insertion, in Albright AL, Pollack EF, Adelson PD (eds): Atlas of Pediatric Neurosurgery. New York , Thieme Medical Publishers, 2000 , 275—280.
30.
Kopell BH, Sala D., Doyle WK, et al: Subfascial implantation of intrathecal baclofen pumps in children: Technical note. Neurosurgery2001;49:753—757.
31.
Grabb PA, Guin-Renfroe S., Meythaler JM: Mid-thoracic catheter tip placement for intrathecal baclofen administration in children with quadriparetic spasticity. Neurosurgery1999;45:833—837.
32.
Kofler M., Kronenberg MF, Rifici C., et al: Epileptiic seizures associated with intrathecal baclofen application . Neurology1994;44: 25—27.
33.
Albright AL , Gilmartin R., Swift D., et al: Long-term intrathecal baclofen for severe spasticity of cerebral origin. J Neurosurg2003;98:291—295.
Butler C., Campbell S.: Evidence of the effects of intrathecal baclofen for spastic and dystonic cerebral palsy. AACPDM Treatment Outcomes Committee Review Panel. Dev Med Child Neurol2000;42:634—645.
38.
Gilmartin R. , Bruce D., Storrs BB, et al: Intrathecal baclofen for management of spastic cerebral palsy: Multicenter trial. J Child Neurol2000;15:71—77.
39.
Campbell SK , Aomeida GL, Penn RD, Corcos DM: The effects of intrathecally administered baclofen on function in patients with spasticity . Phys Ther1995;75:352—362.
40.
Campbell WM , Ferrel A., McLaughlin JF, et al: Long-term safety and efficacy of continuous intrathecal baclofen. Dev Med Child Neurol2002;44:660—665.
41.
Awaad Y., Tayem H., Munoz S., et al. Functional assessment following intrathecal baclofen therapy in children with spastic cerebral palsy. J Child Neurol2003;18:26—34.
42.
Mason C., Gilpin P., McGowan S., et al: The effect of intrathecal baclofen on functional intelligibility of speech. Int J Lang Commun Disord1998;33(Suppl):24—25.
43.
Dan B., Bouilloot E., Bengoetxea A., et al: Effect of intrathecal baclofen on gait control in human hereditary spastic paraparesis. Neurosci Lett2000;280:175—178.
44.
Sgouros S., Seri S.: The effect of intrathecal baclofen on muscle co-contraction in children with spasticity of cerebral origin. Pediatr Neurosurg2002;37:225—230.
45.
Nanninga JB, Frost F., Penn R.: Effect of intrathecal baclofen on bladder and sphincer function. J Urol1989;142:101—105.
46.
Mertens P., Sindou M.: Selective peripheral neurotomies for the treatment of spasticity, in Sindou M, Abbott R, Keravel Y (eds): Neurosurgery for Spasticity. New York, Springer-Verlag,1991,119-132.
47.
Cooper IS, Riklan M., Amin I., et al: Chronic cerebellar stimulation in cerebral palsy. Neurology1976;26:744—753.
48.
Gahm N., Russman B.: Chronic cerebellar stimulation for cerebral palsy: A double-blind study. Neurology1981;31:87—90.
49.
Gottlieb GL , Myklebust BM, Stefoski D., et al: Evaluation of cervical stimulation for chronic treatment of spasticity. Neurology1985;35:699—704.
50.
Siegfried J. : Treatment of spasticity by dorsal cord stimulation . Int Rehabil Med1990;9:31—34.
51.
Narayan RK, Loubser PG, Jankovic J., et al: Intrathecal baclofen for intractable axial dystonia. Neurology1991;41:1141—1142.
52.
Albright AL , Barry MJ, Shafron DH, et al: Intrathecal baclofen for generalized dystonia. Dev Med Child Neurol2001;43:652—657.
53.
Albright AL: Implantation of pumps for treatment of dystonia, in Krauss JK, Jankovic J, Brossman RG (eds): Movement Disorders Surgery . Philadelphia, Lippincott Williams and Wilkins, 2000,316-322.
54.
Cooper IS: 20-year followup study of the neurosurgical treatment of dystonia musculorum deformans, in Eldridge R, Fahn S (eds): Dystonia 1. Advances in Neurology , vol 14. New York, Raven Press, 1976, 423—452.
55.
Marsden CD, Caline DB, Tasker RR, et al: Thalamotomy in generalized dystonia, in Fahn S, Marsden CD, Caline DB (eds): Dystonia 2. Advances in Neurology , vol. 50. New York, Raven Press, 1988,615-631.
56.
Yoshor D., Hamilton W., Ondo W., et al: Comparison of thalamotomy and pallidotomy for the treatment of dystonia. Neurosurgery2001;48:818—826.
57.
Gros C., Frerebeau PH, Perez-Dominguez E., et al:Long term results of stereotaxic surgery for infantile dystonia and dyskinesia . Neurochirurgie1976;19:171—178.
58.
Narabayashi H. : Choreoathetosis and spasticity, in Schaltenbrand G, Walker AE (eds): Stereotaxy of the Human Brain. Anatomical Physiological and Clinical Applications. Stuttgart, Thieme, 1982,532-543.
59.
Andrew J., Fowler CJ, Harrison Mjg: Stereotaxic thalamotomy in 55 cases of dystonia. Brain1983;106:981—1000.
60.
Broggi G., Angelini L., Bono R., et al: Long term results of stereotactic thalamotomy for cerebral palsy . Neurosurgery1983; 12:195—202.
61.
Cardoso F., Jankovic J., Grossman RG, et al: Outcome after stereotactic thalamotomy for dystonia and hemiballismus . Neurosurgery1995;36:501—508.
62.
Yamashiro K. , Tasker R.: Stereotactic thalamotomy for dystonia patients . Stereotact Funct Neurosurg1993 ;60:81—85.
63.
Sungurov EB , Peresedov VV, Markova ED, et al: The surgical results in patients with different forms of torsion dystonia [in Russian] . Zh Vol Neirokhir Im N N Burdenko1998;4:21—24.
Lin JJ, Lin GY, Shih C., et al: Benefit of bilateral pallidotomy in the treatment of generalized dystonia. Case report. J Neurosurg1999;90:974—976.
66.
Vitek JL, Zhang J., Evatt M., et al: Gpi pallidotomy for dystonia: Clinical outcome and neuronal activity, in Fahn S, Marsden CD, DeLong MR (eds): Dystonia 3. Advances in Neurology. Philadelphia , Lippincott-Raven, 1998, 211—219.
67.
Lozano AM, Kumar R., Gross RE, et al: Globus pallidus internus pallidotomy for generalized dystonia . Mov Disord1997;12:865—870.
68.
Gill S., Curran A., Tripp J., et al: Hyperkinetic movement disorder in an 11-year-old child treated with bilateral pallidal stimulators. Dev Med Child Neurol2001;43:350—353.
69.
Angelini L. , Nardocci N., Estienne M., et al: Life-threatening dystonia-dyskinesias in a child: Successful treatment with bilateral pallidal stimulation. Mov Disord2000;15:1010—1012.
70.
Sellal F., Hirsch E., Barth P., et al: A case of symptomatic hemidystonia improved by ventroposterolateral thalamic electrostimulation. Mov Disord1993 ;8:515—518.
71.
Loher TJ, Hasdemir MG, Burgunder J-M., et al: Long-term followup study of chronic globus pallidus internus stimulation for posttraumatic hemidystonia. J Neurosurg2000;92:457—460.
72.
Vayssiere N. , Hemm S., Zanca M., et al: Magnetic resonance imaging stereotactic target localization for deep brain stimulation in dystonic children . J Neurosurg2000;93:784—790.
73.
Vayssiere N. , Hemm S., Cif L., et al: Comparison of atlas- and magnetic resonance imaging-based stereotactic targeting of the globus pallidus internus in the performance of deep brain stimulation for treatment of dystonia. J Neurosurg2002;96:673—679.
74.
Hamby WB: The surgical treatment of dystonia musculorum deformans. J Neurosurg1953;10:490—495.
75.
Narabayshi H.: Stereotaxic surgery for athetosis or the spastic state of cerebral palsy. ConfinNeurol1962; 22:364—347.
76.
Laitinen LV : Short-term results of stereotaxic treatment for infantile cerebral palsy. ConfinNeurol1965;26:258—263.
77.
Mundinger F. , Riechert T., Disselhoff J.: Long term results of stereotaxic operations on extra-pyramidal hyperkinesis (excluding parkinsonism). ConfinNeurol1970;32:71—78.
78.
Hassler R.: Sagittal thalamotomy for relief of motor disorders in cases of double athetosis and cerebral palsy. ConfinNeurol1972;34:18—28.
79.
Thompson T. , Albright AL, Kondziolka D.: Thalamic stimulation for choreiform movement disorders in children. J Neurosurg2000;92:718—721.
80.
Ohye C., Miyazaki M., Hirai T., et al: Stereotactic selective thalamotomy for the treatment of tremor type cerebral palsy in adolescence. ChildsBrain1983;10:157—167.
81.
Broggi G., Brock S., Franzini A., et al: A case of posttraumatic tremor treated by chronic stimulation of the thalamus. Mov Disord1993;8:206—208.
82.
Fromm GH, Terrence CF: Comparison of L-baclofen and racemic baclofen in trigeminal neuralgia . Neurology1987;37:1725—1728.
83.
Albright AL : Intrathecal L-baclofen for cerebral spasticity: Case report. Neurology1995;45:2110—2111.
