Prevention of severe contractures might replace multilevel surgery in cerebral palsy: results of a population-based health care programme and new techniques to reduce spasticity.
During the 1990s three new techniques to reduce spasticity and dystonia in children with cerebral palsy (CP) were introduced in southern Sweden: selective dorsal rhizotomy, continuous intrathecal baclofen infusion and botulinum toxin treatment. In 1994 a CP register and a health care programme, aimed to prevent hip dislocation and severe contractures, were initiated in the area. The total population of children with CP born 1990-1991, 1992-1993 and 1994-1995 was evaluated and compared at 8 years of age. In non-ambulant children the passive range of motion in hip, knee and ankle improved significantly from the first to the later age groups. Ambulant children had similar range of motion in the three age groups, with almost no severe contractures. The proportion of children treated with orthopaedic surgery for contracture or skeletal torsion deformity decreased from 40 to 15% (P = 0.0019). One-fifth of the children with spastic diplegia had been treated with selective dorsal rhizotomy. One-third of the children born 1994-1995 had been treated with botulinum toxin before 8 years of age. With early treatment of spasticity, early non-operative treatment of contracture and prevention of hip dislocation, the need for orthopaedic surgery for contracture or torsion deformity is reduced, and the need for multilevel procedures seems to be eliminated.
Hägglund
Gunnar
G
Department of Orthopedics, University Hospital, Lund, Sweden. Gunnar.Hagglund@ort.lu.se
Andersson
Sofia
S
Düppe
Henrik
H
Lauge-Pedersen
Henrik
H
Pedertsen
Henrik Lauge
HL
Nordmark
Eva
E
Westbom
Lena
L
D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D001418:Baclofen / Q000627:therapeutic use; D001905:Botulinum Toxins / Q000627:therapeutic use; D002547:Cerebral Palsy / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000503:physiopathology / Q000517:prevention & control*; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000517:prevention & control; D006801:Humans; D007260:Infusion Pumps; D007278:Injections, Spinal; D035002:Lower Extremity / Q000503:physiopathology; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D009128:Muscle Spasticity / Q000628:therapy*; D018482:Muscle, Skeletal / Q000503:physiopathology*; D015397:Program Evaluation; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D012042:Registries; D019051:Rhizotomy; D016896:Treatment Outcome
D018726:Anti-Dyskinesia Agents; D009125:Muscle Relaxants, Central; D001905:Botulinum Toxins; D001418:Baclofen