title: Effects of continuous intrathecal baclofen infusion and selective posterior rhizotomy on upper extremity spasticity.
abstract: This study was performed to compare the effects of continuous intrathecal baclofen infusion (CIBI) and selective posterior rhizotomy (SPR) on upper extremity (UE) spasticity and range of motion in children with cerebral palsy. Spasticity was assessed with the Ashworth scale of muscle tone and range of motion was evaluated. Thirty-eight patients who had been treated with CIBI for at least 6 months were paired, according to pretreatment UE muscle tone and functional status, with 38 patients who had undergone SPR. The CIBI dosage had been titrated to reduce over lower extremity spasticity and improve lower extremity function, rather than to improve UE tone. The pretreatment muscle tone in the two groups was virtually identical. The UE tone of children treated with CIBI decreased from 2.07 prior to treatment to 1.66 after 1 year (p < 0.01). The tone of children treated with SPR decreased from 2.03 to 1.70 after 1 year (p = 0.005). In that group, the likelihood of a clinically significant reduction in muscle tone (one point or greater) was greater in children with a higher pretreatment UE muscle tone. There was no correlation between the percentage of posterior lumbar roots divided in SPR and the subsequent reduction in UE tone. There were no significant changes in the range of motion in any UE joint, at either 6 or 12 months, after either CIBI or SPR. We conclude that both CIBI and SPR significantly reduce UE spasticity, in addition to the previously documented reduction in lower extremity spasticity.
authors.affiliation: Department of Neurosurgery, Children's Hospital of Pittsburgh, PA 15213, USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Albright
authors.forename: M J
authors.initials: MJ
authors.lastname: Barry
authors.forename: M P
authors.initials: MP
authors.lastname: Fasick
authors.forename: J
authors.initials: J
authors.lastname: Janosky
mesh_terms: D001132:Arm; D001418:Baclofen / Q000008:administration & dosage* / Q000627:therapeutic use; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D006801:Humans; D007231:Infant, Newborn; D007278:Injections, Spinal; D007866:Leg; D009125:Muscle Relaxants, Central / Q000008:administration & dosage* / Q000627:therapeutic use; D009128:Muscle Spasticity / Q000188:drug therapy / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000187:drug effects; D019051:Rhizotomy
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen