Log in

Neurosurgical intervention during resistant phase of motor development of cerebral palsied

  • Symposium: Early Interventional Therapy
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Positive neurological phenomena of cerebral palsied, especially spasticity are best relieved by neurosurgical procedures. But the procedures are indicated only in those cases who have developed resistance to nonsurgical therapies, especially rehabilitative therapy. However, surgical procedure cannot teach a child how to perform motor functions. Therefore, rehabilitative therapy plays immense role in development of motor functions which can be improved best during the physical developmental and learning ability age of the child. Therefore, it is recommended to start neurodevelopmental therapy at a few weeks age of the child, and perform the neurosurgical procedure as soon as the child develops resistance to the therapy. The child has to resume back to therapy following the surgery for further motor development.

There are various neurosurgical procedures for the relief of positive neurological phenomena. The present article includes brief description of the procedures and review of the literature. The authors feel that the selective posterior rhizotomy is perhaps the best procedure among all other ablative procedures for the relief of diffuse spasticity of both the lower limbs in strictly selected cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Schulman JH, Davis R, Nanes M. Cerebellar stimulation for spastic cerebral palsy: A preliminary report; on-going double blind study.PACE 1987; 10: 226–231.

    PubMed  CAS  Google Scholar 

  2. Penn RD. Chronic cerebellar stimulation for cerebral palsy. A review.Neurosurgery 1982; 10(1): 116–121.

    Article  PubMed  CAS  Google Scholar 

  3. Davis R, Barolat-Romana G, Engle H. Chronic cerebellar stimulation for cerebral palsy-five year study.Acta Neurochir [Suppl](Wien) 1980; 30: 317–332.

    CAS  Google Scholar 

  4. Schvarcz JR, Sica RE, Morita E. Chronic self-stimulation of the dentate nucleus for the relief of spasticity.Acta Neurochir [Suppl] (Wien) 1980; 30: 351–359.

    CAS  Google Scholar 

  5. Davis R, Cullen RF Jr, Flitter MA et al. Control of spasticity and involuntary movements-cerebellar stimulation.Appl Neurophysiol 1977-78; 40(2–4): 135–140.

    Article  PubMed  Google Scholar 

  6. Penn RD, Gottlieb GL, Agarwal GC. Cerebellar stimulation in man: Quantitative changes in spasticity.J Neurosurg 1978; 48(5): 779–786.

    PubMed  CAS  Google Scholar 

  7. Winkelmuller W, Seidel BU, Dietz H. The influence of permanent cerebellar stimulation on senso-motor disorders in cerebral palsy (author's translation) (Germany).Neurochirurgia 1977; 20(6): 179–185.

    PubMed  CAS  Google Scholar 

  8. Coopere IS, Riklan M, Amin I et al. Chronic cerebellar stimulation in cerebral palsy.Neurology 1976; 26(8): 744–753.

    Google Scholar 

  9. Davis R, Schulman J, Delehanty A. Cerebellar stimulation for cerebral palsy-double blind study.Acta Neurochir [Suppl] (Wien) 1987; 39: 126–128.

    CAS  Google Scholar 

  10. Galanda M, Nadvornik P, Fodor B. Stereotactic approach to therapeutic stimulation of cerebellum for spasticity.Acta Neurochir [Suppl] (Wien) 1980; 30: 345–349.

    CAS  Google Scholar 

  11. Kanaka TS. Stereotaxic surgery for cerebral palsy. In: Ramamurthy B, Tandon PN, eds.Text Book of Neurosurgery, Vol 2, New Delhi: National Book Trust, India, 1980: 1070–1083.

    Google Scholar 

  12. Kanaka TS, Balasubramaniam V. Dentato-Thalamotomy in infantile hemiplegia.Confinia Neurol 1975; 37: 271–276.

    Article  CAS  Google Scholar 

  13. Galanda M, Nadvorn P, Sramka M. Combined transtentorial dentotomy with pulvinatotomy in cerebral palsy.Acta Neurochir [Suppl] (Wien) 1977 (24): 21–26.

    Google Scholar 

  14. Gornall P, Hitchcock E, Kirkland IS. Stereotaxic neurosurgery in the management of cerebral palsy.Dev Med Child Neurol 1975; 17(3): 279–286.

    Article  PubMed  CAS  Google Scholar 

  15. Siegfried J, Lazorthes Y, Broggi G et al. Functional neurosurgery of cerebral palsy.Neurochirurgie 1985; 31 Suppl 1: 1–118.

    PubMed  Google Scholar 

  16. Siegfried J, Verdie JC. Long-term assessment of stereotactic dentatotomy for the spasticity and other disorders.Acta Neurochirur [Suppl] (Wien) 1977 (24):41–48.

    Google Scholar 

  17. Blond S, Musolino A, Munari C et al. Value of bifocal stereotaxic destruction in case of dyskinesia in patients with a motor deficit of cerebral origin (Fre).Neurochirurgie 1987; 33(6): 445–461.

    Google Scholar 

  18. Nesterov LN, Kravtosov U, Skupchenko VV. Stereotaxic surgery in the hyperkinetic form of infantile cerebral palsy.Vopr Neirokhirurgii 1976; (5): 14–17.

    Google Scholar 

  19. Broggi G, Angelini L, Bono R. Long term results of stereotaxtic thalamotomy for cerebral palsy.Neurosurgery 1983; 12(2): 195–202.

    Article  PubMed  CAS  Google Scholar 

  20. Kanaka TS, Balasubramaniam V, Ramanujam RB et al. Sterotaxic surgery in cerebral palsy—A study of 57 cases.Neurology India 1970; 21: 56–59.

    Google Scholar 

  21. Kanaka TS, Stereotaxic surgery for cerebral palsy.Proc Inst Neurol Madras 1973; 3: 37–53.

    Google Scholar 

  22. Waltz JM. Spinal cord stimulation in the treatment of neurological disorders. Department of neurological surgery. St. Barnabas Hospital, Third Avenue, New York 104457. (Personal communication).

  23. Gybels J, Roost DV. Spinal cord stimulation for spasticity. In: Sindou M, Abbott R, Kereavel Y, eds.Neurosurgery for Spasticity—A multi-disciplinary approach New York: Springer-Verlag Wien, 1991: 73–81.

    Google Scholar 

  24. Speelman JD. Cervical epidural spinal cord stimulation in infantile encephalopathy.Nederlands Tijdschrift Voor Geneeskunde 1990; 134(36): 1732–1735.

    PubMed  CAS  Google Scholar 

  25. Hugenholtz H, Humphreys P, McIntyre WM et al. Cervical spinal cord stimulation for spasticity in cerebral palsy.Neurosurgery 1988; 22(4): 707–714.

    Article  PubMed  CAS  Google Scholar 

  26. Rechard DP, Jefferey SK. Intrathecal baclofen in the long term management of severe spasticity neurosurgery: In: Park TS, Phillips LH, Peacock WJ, eds.State of the Art Review. Philadelphia: Hanley Belfus, Inc. 1989; 4: 325–332.

    Google Scholar 

  27. Zierski J, Muller H, Dralle D, et al. Implanted pump systems for treatment of spasticityActa Neurochirur [Suppl] (Wien) 1988; 43: 94–99.

    CAS  Google Scholar 

  28. Bishoff W. Zur dorsalen longitudinalen Myelotomic Zbl.Neurochir 1967; 28: 123–126.

    Google Scholar 

  29. Laitenen LV. Longitudinal myelotomy for spasticity. In: Sindou M. Abbott R, and Keranel, eds.Neurosurgery for Spasticity, A Multidisciplinary Approach. New York: Springer Y.-Verlag Wiem, 1991: 183–186.

    Google Scholar 

  30. Yamada S, Dayes L, Knierim D et al. Control of mass spasms by longitudinal myelotomy. Management of spasticity in cerebral palsy and spinal cord injury. In: Park TS, Phillips LH, Peacock WJ.State of the Art Reviews, Philadelphia: Hanley & Belfus Inc, 1989; 4: 345–354.

    Google Scholar 

  31. Sindou M, Misfud JJ, Boisson D et al. Selective posterior rhizotomy in the dorsal root entry zone for treatment of hyperspasticity and pain in one monoplegic upper limb.Neurosurgery 1986; 18: 587–595.

    Article  PubMed  CAS  Google Scholar 

  32. Fasano VA, Broggi GB, Ramana G et al. Surgical treatment of spasticity in cerebral palsy,Child's Brain 1978; 4: 289–305.

    PubMed  CAS  Google Scholar 

  33. Peacock WJ, Eastman RW: The neurosurgical management of spasticity.South Afr Med J 1981; 60: 849–850.

    CAS  Google Scholar 

  34. Laitinen LB, Nilsson S, Fuglmeyer AR. Selective posterior rhizotomy for treatment of spasticity.J Neurosurg 1983; 58: 895–899.

    Article  PubMed  CAS  Google Scholar 

  35. Fasano VA, Broggi G. Functional posterior rhizotomy.State of the Art Review 1989: 4: 409–412.

    Google Scholar 

  36. Peacock WJ, Staudt L. Selective posterior rhizotomy; History and results.State of the Art Reviews 1989; 4: 403–408.

    Google Scholar 

  37. Abbott R, Foren SL, Johan M. Selective posterior rhizotomy for the treatment of spasticity.Childs Nerv Syst 1989; 5: 337–346.

    Article  PubMed  CAS  Google Scholar 

  38. Sindou M, Mertens P. Selective neurotomy of the tibial nerve for the treatment of the spastic foot.Neurosurgery 1988; 23(6): 738–744.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Purohit, A.K., Dinakar, I. Neurosurgical intervention during resistant phase of motor development of cerebral palsied. Indian J Pediatr 59, 707–717 (1992). https://doi.org/10.1007/BF02859405

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02859405

Key words

Navigation