Rhizotomibehandling af børn med svaer spastisk cerebral parese

Translated title of the contribution: Rhizotomy for children with severe spastic cerebral palsy

Niels Ove Illum, Lisbeth Torp-Pedersen, Steen Midholm, Peter E Selmar, Kurt Simesen

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

INTRODUCTION: Severe spasticity is a limiting factor for motor development in children with spastic cerebral palsy. Botulinum toxin, intrathecal baclofen and peroral baclofen all reduce spasticity but might also limit improvements in functional development over time. In the selective dorsal or posterior rhizotomy (SDR) approach, afferent sensory nerve fibers are cut while efferent motor fibers are preserved. In this way spasticity is reduced and motor functions can improve. SDR is an established treatment method, and the first Danish study is reported.

MATERIAL AND METHODS: Twenty Danish children with severe spastic cerebral palsy were evaluated, operated on and trained over a 10-year period from 1992 to 2002. Those on whom operation was performed ranged from 4 to 16 years of age (median 8 years), and training and follow-up took place during the ensuing 60 months. At time of operation, 20-40% of 100-120 dorsal root filaments were cut, corresponding to the II-V lumbar and I-II sacral nerve roots.

RESULTS: Spasticity in the lower extremities measured before SDR showed an average Asworth score of 2.0-4.2 (median 3.1). Eighteen months after SDR, scores were 0.8-1.8 (median 1.0), and at 60 months 0.8-1.8 (median 1.0). Both post-operative values were significant (t-test, p < 0.001). Mobility improved over a longer period of time: the Illinois St. Louis scale values before SDR were 1-9 (median 6), while at 18 months post-operative they were 1-9 (median 5) and at 60 months post-operative 1-9 (median 4). At 18 months, scores were non-significant (t test, p > 0.05), but at 60 months they were significant (t < 0.05). According to the Montgomery scale, 4 children had worse post-operative scores and 12 children had better scores. When comparing age at operation with outcome, we observed a certain degree of concordance between relatively younger age and better post-operative muscular function (Pearson's r = 0.8).

CONCLUSION: SDR resulted in early and lasting reduction in spasticity in all 20 children operated upon. Improved muscular function, however, required training and time. Not until 60 months after operation were functional measures significantly better than the preoperative values.

Original languageDanish
JournalUgeskrift for Laeger
Volume168
Issue number8
Pages (from-to)785-9
Number of pages5
Publication statusPublished - 20. Feb 2006

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Rhizotomy
Cerebral Palsy
Nerve Fibers

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Illum, N. O., Torp-Pedersen, L., Midholm, S., Selmar, P. E., & Simesen, K. (2006). Rhizotomibehandling af børn med svaer spastisk cerebral parese. Ugeskrift for Laeger, 168(8), 785-9.
Illum, Niels Ove ; Torp-Pedersen, Lisbeth ; Midholm, Steen ; Selmar, Peter E ; Simesen, Kurt. / Rhizotomibehandling af børn med svaer spastisk cerebral parese. In: Ugeskrift for Laeger. 2006 ; Vol. 168, No. 8. pp. 785-9.
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title = "Rhizotomibehandling af b{\o}rn med svaer spastisk cerebral parese",
abstract = "INTRODUCTION: Severe spasticity is a limiting factor for motor development in children with spastic cerebral palsy. Botulinum toxin, intrathecal baclofen and peroral baclofen all reduce spasticity but might also limit improvements in functional development over time. In the selective dorsal or posterior rhizotomy (SDR) approach, afferent sensory nerve fibers are cut while efferent motor fibers are preserved. In this way spasticity is reduced and motor functions can improve. SDR is an established treatment method, and the first Danish study is reported.MATERIAL AND METHODS: Twenty Danish children with severe spastic cerebral palsy were evaluated, operated on and trained over a 10-year period from 1992 to 2002. Those on whom operation was performed ranged from 4 to 16 years of age (median 8 years), and training and follow-up took place during the ensuing 60 months. At time of operation, 20-40{\%} of 100-120 dorsal root filaments were cut, corresponding to the II-V lumbar and I-II sacral nerve roots.RESULTS: Spasticity in the lower extremities measured before SDR showed an average Asworth score of 2.0-4.2 (median 3.1). Eighteen months after SDR, scores were 0.8-1.8 (median 1.0), and at 60 months 0.8-1.8 (median 1.0). Both post-operative values were significant (t-test, p < 0.001). Mobility improved over a longer period of time: the Illinois St. Louis scale values before SDR were 1-9 (median 6), while at 18 months post-operative they were 1-9 (median 5) and at 60 months post-operative 1-9 (median 4). At 18 months, scores were non-significant (t test, p > 0.05), but at 60 months they were significant (t < 0.05). According to the Montgomery scale, 4 children had worse post-operative scores and 12 children had better scores. When comparing age at operation with outcome, we observed a certain degree of concordance between relatively younger age and better post-operative muscular function (Pearson's r = 0.8).CONCLUSION: SDR resulted in early and lasting reduction in spasticity in all 20 children operated upon. Improved muscular function, however, required training and time. Not until 60 months after operation were functional measures significantly better than the preoperative values.",
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Illum, NO, Torp-Pedersen, L, Midholm, S, Selmar, PE & Simesen, K 2006, 'Rhizotomibehandling af børn med svaer spastisk cerebral parese', Ugeskrift for Laeger, vol. 168, no. 8, pp. 785-9.

Rhizotomibehandling af børn med svaer spastisk cerebral parese. / Illum, Niels Ove; Torp-Pedersen, Lisbeth; Midholm, Steen; Selmar, Peter E; Simesen, Kurt.

In: Ugeskrift for Laeger, Vol. 168, No. 8, 20.02.2006, p. 785-9.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Rhizotomibehandling af børn med svaer spastisk cerebral parese

AU - Illum, Niels Ove

AU - Torp-Pedersen, Lisbeth

AU - Midholm, Steen

AU - Selmar, Peter E

AU - Simesen, Kurt

PY - 2006/2/20

Y1 - 2006/2/20

N2 - INTRODUCTION: Severe spasticity is a limiting factor for motor development in children with spastic cerebral palsy. Botulinum toxin, intrathecal baclofen and peroral baclofen all reduce spasticity but might also limit improvements in functional development over time. In the selective dorsal or posterior rhizotomy (SDR) approach, afferent sensory nerve fibers are cut while efferent motor fibers are preserved. In this way spasticity is reduced and motor functions can improve. SDR is an established treatment method, and the first Danish study is reported.MATERIAL AND METHODS: Twenty Danish children with severe spastic cerebral palsy were evaluated, operated on and trained over a 10-year period from 1992 to 2002. Those on whom operation was performed ranged from 4 to 16 years of age (median 8 years), and training and follow-up took place during the ensuing 60 months. At time of operation, 20-40% of 100-120 dorsal root filaments were cut, corresponding to the II-V lumbar and I-II sacral nerve roots.RESULTS: Spasticity in the lower extremities measured before SDR showed an average Asworth score of 2.0-4.2 (median 3.1). Eighteen months after SDR, scores were 0.8-1.8 (median 1.0), and at 60 months 0.8-1.8 (median 1.0). Both post-operative values were significant (t-test, p < 0.001). Mobility improved over a longer period of time: the Illinois St. Louis scale values before SDR were 1-9 (median 6), while at 18 months post-operative they were 1-9 (median 5) and at 60 months post-operative 1-9 (median 4). At 18 months, scores were non-significant (t test, p > 0.05), but at 60 months they were significant (t < 0.05). According to the Montgomery scale, 4 children had worse post-operative scores and 12 children had better scores. When comparing age at operation with outcome, we observed a certain degree of concordance between relatively younger age and better post-operative muscular function (Pearson's r = 0.8).CONCLUSION: SDR resulted in early and lasting reduction in spasticity in all 20 children operated upon. Improved muscular function, however, required training and time. Not until 60 months after operation were functional measures significantly better than the preoperative values.

AB - INTRODUCTION: Severe spasticity is a limiting factor for motor development in children with spastic cerebral palsy. Botulinum toxin, intrathecal baclofen and peroral baclofen all reduce spasticity but might also limit improvements in functional development over time. In the selective dorsal or posterior rhizotomy (SDR) approach, afferent sensory nerve fibers are cut while efferent motor fibers are preserved. In this way spasticity is reduced and motor functions can improve. SDR is an established treatment method, and the first Danish study is reported.MATERIAL AND METHODS: Twenty Danish children with severe spastic cerebral palsy were evaluated, operated on and trained over a 10-year period from 1992 to 2002. Those on whom operation was performed ranged from 4 to 16 years of age (median 8 years), and training and follow-up took place during the ensuing 60 months. At time of operation, 20-40% of 100-120 dorsal root filaments were cut, corresponding to the II-V lumbar and I-II sacral nerve roots.RESULTS: Spasticity in the lower extremities measured before SDR showed an average Asworth score of 2.0-4.2 (median 3.1). Eighteen months after SDR, scores were 0.8-1.8 (median 1.0), and at 60 months 0.8-1.8 (median 1.0). Both post-operative values were significant (t-test, p < 0.001). Mobility improved over a longer period of time: the Illinois St. Louis scale values before SDR were 1-9 (median 6), while at 18 months post-operative they were 1-9 (median 5) and at 60 months post-operative 1-9 (median 4). At 18 months, scores were non-significant (t test, p > 0.05), but at 60 months they were significant (t < 0.05). According to the Montgomery scale, 4 children had worse post-operative scores and 12 children had better scores. When comparing age at operation with outcome, we observed a certain degree of concordance between relatively younger age and better post-operative muscular function (Pearson's r = 0.8).CONCLUSION: SDR resulted in early and lasting reduction in spasticity in all 20 children operated upon. Improved muscular function, however, required training and time. Not until 60 months after operation were functional measures significantly better than the preoperative values.

KW - Adolescent

KW - Cerebral Palsy

KW - Child

KW - Child, Preschool

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Muscle Spasticity

KW - Rhizotomy

KW - Treatment Outcome

M3 - Tidsskriftartikel

C2 - 16499843

VL - 168

SP - 785

EP - 789

JO - Ugeskrift for Laeger

JF - Ugeskrift for Laeger

SN - 0041-5782

IS - 8

ER -

Illum NO, Torp-Pedersen L, Midholm S, Selmar PE, Simesen K. Rhizotomibehandling af børn med svaer spastisk cerebral parese. Ugeskrift for Laeger. 2006 Feb 20;168(8):785-9.