Combined ablative neurosurgical procedures in a patient with mixed spastic and dystonic cerebral palsy.
BACKGROUND
Harmful generalized spasticity is an obstacle in rehabilitation and caregiving. Neurosurgical intervention is a therapeutic option for patients with severe spasticity who do not respond to nonoperative management. Currently, intrathecal baclofen therapy (ITB) is a good alternative treatment for such patients. However, the ITB device is costly and the intrathecal drug is not available in Thailand.


METHODS
We report a combined use of ablative neurosurgical procedures in a patient with severe generalized spasticity and disabling cervical dystonia (CD). The assembled operations including selective peripheral denervation for CD, microsurgical dorsal root entry zone lesion for upper limb spasticity, and selective dorsal rhizotomy for lower limb spasticity were conducted in a single session. Furthermore, recurrent spasticity of the upper extremities was subsequently treated by selective peripheral neurotomy.


RESULTS
The spasticity and CD totally disappeared after all operations. The patient became able to sit and perform head turning. Additionally, we also found an improvement in swallowing and the voluntary movement of the lower limbs.
Sitthinamsuwan
Bunpot
B
Department of Surgery, Mahidol University, Bangkok, Thailand. bunpotsi @ yahoo.com
Chanvanitkulchai
Kannachod
K
Nunta-Aree
Sarun
S
Kumthornthip
Witsanu
W
Pisarnpong
Apichart
A
Ploypetch
Teerada
T
D000328:Adult; D001921:Brain / Q000601:surgery*; D002547:Cerebral Palsy / Q000601:surgery*; D003680:Deglutition Disorders / Q000601:surgery; D006801:Humans; D008297:Male; D009068:Movement; D019051:Rhizotomy; D014103:Torticollis / Q000601:surgery*; D016896:Treatment Outcome