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Intrathecal baclofen, selective dorsal rhizotomy, and extracorporeal shockwave therapy for the treatment of spasticity in cerebral palsy: a systematic review

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Abstract

Cerebral palsy (CP) is a chronic congenital disorder as the result of abnormal brain development. Children suffering from CP often battle debilitating chronic spasticity, which has been the focus of recent academic literature. In this systematic review, the authors aim to update the current neuromodulation procedures for the treatment of spasticity associated with CP in all age groups. A systematic review following was conducted using PubMed from inception to 2020. After initial title and abstract screening, 489 articles were identified, and 48 studies met the inclusion criteria for this review. In total, a majority of the published articles of treatments for CP were reporting the use of selective dorsal rhizotomy (SDR) (54%), and the remainder were of intrathecal baclofen (ITB) pumps (29%) and extracorporeal shockwave therapy (ESWT) (17%). Each method was found to have improvement of spasticity at a rate that achieved statistical significance. ITB pump therapy is an all-encompassing method of treating spasticity in children from CP, as it allows for a less invasive treatment that can be titrated to individual patient needs; however, its disadvantages include its long-term maintenance requirements. SDR appears to be an effective method for permanent spasticity relief in young patients. ESWT is a more recent and innovative technique for offering relief of spasticity while being minimally invasiveness. Further studies are needed to establish optimal frequencies and sites of application for ESWT.

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Data availability

All references and data included in this systematic review are provided in the tables of this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA

    Amogh Kudva, Justin Gold, Yehuda Herschman & Antonios Mammis

  2. Department of Neurosurgery, University of California, La Jolla, San Diego, CA, USA

    Mickey E. Abraham

  3. Mercer University School of Medicine, Savannah, GA, USA

    Neal A. Patel

  4. Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, 3400 North Charles Street, Baltimore, MD, USA

    Julian L. Gendreau

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  1. Amogh Kudva
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  2. Mickey E. Abraham
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  3. Justin Gold
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  4. Neal A. Patel
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  6. Yehuda Herschman
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Contributions

Amogh Kudva was involved with the initial database search, data extraction, and initial manuscript preparation; Mickey E. Abraham provided initial conceptualization of the project and manuscript editing; Justin Gold was involved with the initial database search, data extraction, and manuscript editing; Neal Patel was involved with critical review of the manuscript and manuscript editing; Julian L. Gendreau was involved with critical review of the manuscript, correspondence for manuscript submission, and revisions; Yehuda Herschman provided critical review of the manuscript; Antonios Mammis provided key supervision for the project.

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Correspondence to Julian L. Gendreau.

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Kudva, A., Abraham, M.E., Gold, J. et al. Intrathecal baclofen, selective dorsal rhizotomy, and extracorporeal shockwave therapy for the treatment of spasticity in cerebral palsy: a systematic review. Neurosurg Rev 44, 3209–3228 (2021). https://doi.org/10.1007/s10143-021-01550-0

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