title: Coupled obturator neurotomies and lidocaine intrathecal infusion to treat bilateral adductor spasticity and drug-refractory pain.
abstract: Spastic diplegia is present in three-fourths of children with cerebral palsy, interfering with gait and frequently accompanied by severe pain. The authors report the case of a 28-year-old woman with history of perinatal hypoxia, who presented with cerebral palsy and severe spastic diplegia (Ashworth Scale Score 4, Tardieu Scale Score 5) and was confined to a wheelchair. She complained of pain in the left hip and knee with mixed neuropathic and somatic components. She consistently rated pain intensity as 10 of 10 on a visual analog scale, and her symptoms were resistant to multiple treatments. The patient underwent selective bilateral adductor myotomies and the implantation of an infusion pump for intrathecal lidocaine application. Postoperative control of pain and spasticity was dramatic (scores of 0 on the Ashworth, Tardieu, and visual analog scales) and persisted throughout a follow-up period of 36 months. This is the first report in the literature of combined selective neurotomies for the treatment of spasticity and chronic lidocaine subarachnoid infusion to treat associated pain. This therapy could represent an alternative to treat spasticity associated with neuropathic and somatic pain.
authors.affiliation: Functional Neurosurgery, Stereotaxy, and Radiosurgery Unit, Mexico General Hospital, Mexico City, Mexico. josecarrilloruiz@yahoo.com
authors.forename: José D
authors.initials: JD
authors.lastname: Carrillo-Ruiz
authors.forename: Pablo
authors.initials: P
authors.lastname: Andrade
authors.forename: Nora
authors.initials: N
authors.lastname: Godínez-Cubillos
authors.forename: María L
authors.initials: ML
authors.lastname: Montes-Castillo
authors.forename: Fiacro
authors.initials: F
authors.lastname: Jiménez
authors.forename: Ana L
authors.initials: AL
authors.lastname: Velasco
authors.forename: Guillermo
authors.initials: G
authors.lastname: Castro
authors.forename: Francisco
authors.initials: F
authors.lastname: Velasco
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications; D005260:Female; D005311:Fetal Hypoxia / Q000150:complications; D005500:Follow-Up Studies; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D009128:Muscle Spasticity / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D019635:Neurosurgical Procedures; D009776:Obturator Nerve / Q000601:surgery*; D010146:Pain / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D010147:Pain Measurement; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine