title: Short- and long-term effects of selective dorsal rhizotomy on gross motor function in ambulatory children with spastic diplegia.
abstract: OBJECTIVE
  The primary aim of this prospective cohort study was to evaluate the short-term (1 year) and long-term (mean 6 years) effects of selective dorsal rhizotomy (SDR) on gross motor function and spasticity in ambulatory children with spastic diplegia. Secondary aims were to investigate side effects, additional treatment during follow-up (botulinum toxin type A injections or orthopedic surgery), and parental satisfaction.
  
  
  METHODS
  Thirty-three children who had undergone SDR at a mean age of 6 years and 7 months (± 2 years) were included. There were 7 children at Gross Motor Function Classification System (GMFCS) Level I, 7 at Level II, and 19 at Level III. Gross motor function was assessed with the Gross Motor Function Measure-66 (GMFM-66). Spasticity was measured according to a modified Tardieu scale. Side effects, additional treatment, and parental satisfaction were recorded using a parental questionnaire and medical records.
  
  
  RESULTS
  At 1-year follow-up, mean GMFM-66 scores improved significantly by 4.3 ± 4.1 points. Children at GMFCS Levels I and II showed significantly more improvement (7.2 points) on the GMFM-66 compared with children at GMFCS Level III (2.9 points). On long-term follow-up (mean 6 years ± 22 months), mean GMFM-66 scores improved significantly by 6.5 ± 5.9 points, without a difference between children at GMFCS Levels I and II and Level III. No relapse of spasticity was noted. Ten children (30%) needed orthopedic surgery and 13 children (39%) received botulinum toxin type A treatment after SDR. Twenty (91%) of the 22 parents who answered the questionnaire at long-term follow-up believed that their child's functioning had improved after SDR.
  
  
  CONCLUSIONS
  Selective dorsal rhizotomy resulted in short- and long-term improvements in gross motor function, without relapse of spasticity. However, the majority of the children still needed additional surgery or botulinum toxin A treatment.
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands. pem.vanschie@vumc.nl
authors.forename: Petra E M
authors.initials: PE
authors.lastname: van Schie
authors.forename: Maaike
authors.initials: M
authors.lastname: Schothorst
authors.forename: Annet J
authors.initials: AJ
authors.lastname: Dallmeijer
authors.forename: R Jeroen
authors.initials: RJ
authors.lastname: Vermeulen
authors.forename: Willem J R
authors.initials: WJ
authors.lastname: van Ouwerkerk
authors.forename: Rob L M
authors.initials: RL
authors.lastname: Strijers
authors.forename: Jules G
authors.initials: JG
authors.lastname: Becher
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D002547:Cerebral Palsy / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009048:Motor Skills / Q000502:physiology; D009460:Neurologic Examination; D020336:Paraparesis, Spastic / Q000235:genetics / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D019051:Rhizotomy / Q000379:methods*; D013122:Spinal Diseases / Q000209:etiology
chemical_list: D019274:Botulinum Toxins, Type A