title: Deep anterior cerebellar stimulation reduces symptoms of secondary dystonia in patients with cerebral palsy treated due to spasticity.
abstract: BACKGROUND
  Deep anterior cerebellar stimulation (DACS) is a neuromodulation therapy of spasticity. Bilateral DACS is applied in young patients with cerebral palsy (CP). In these patients symptoms of spasticity coexist with symptoms of focal or segmental dystonia, which can cause chronic pain. We performed the study to investigate the therapeutic effects of DACS in spasticity, secondary dystonia and pain.
  
  
  METHODS
  We examined 10 from 13 patients with CP treated with DACS due to spasticity in years 2006-2012. We compared Ashworth scores of spasticity, VAS scale of pain and UDRS (Unified Dystonia Rating Scale) score before DACS and after it in follow-up lasting from 2 to 11 years it in these patients basing on clinical examination and evaluating forms given by the patients or parents.
  
  
  RESULTS
  We received statistically significant reduction of spasticity in upper extremities (median: from 3 to 1,5 in Ashworth scale) in 8 patients (p = 0,01), in lower extremities in 7 patients (median: from 3 to 1,75) (p = 0,02). Symptoms of focal dystonia were reduced. Total score for the UDRS (median = 18,0 before surgery) after DACS decreased significantly (median = 10,3) (p = 0,043). Change in consecutive parts of UDRS before (median = 1,6) and after (median = 1,0) surgery in 7 patients had statistical significance (p = 0,0179). There were not significant changes in intensity of pain before and after surgery (p = 0,108).
  
  
  CONCLUSIONS
  Chronic bilateral DACS aimed for spasticity treatment not only decreases muscular tone in quadriplegic or paraplegic patients with CP but also is associated with reduction of symptoms of focal or segmental, secondary dystonia.
authors.affiliation: Department of Neurosurgery, 10(th) Military Research Hospital, Powstancow Warszawy 5, 85-681 Bydgoszcz, Poland. Electronic address: psokal@wp.pl.
authors.forename: Paweł
authors.initials: P
authors.lastname: Sokal
authors.affiliation: Department of Neurosurgery, 10(th) Military Research Hospital, Powstancow Warszawy 5, 85-681 Bydgoszcz, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Rudaś
authors.affiliation: Faculty of Health Sciences, Nicolaus Copernicus University, Jagielonska 13, 85-067 Bydgoszcz, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Harat
authors.affiliation: Department of Pathology, Nicolaus Copernicus University, Jagielonska 13, 85-067 Bydgoszcz, Poland.
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Szylberg
authors.affiliation: Department of Neurosurgery, 10(th) Military Research Hospital, Powstancow Warszawy 5, 85-681 Bydgoszcz, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Zieliński
mesh_terms: D000293:Adolescent; D000328:Adult; D002531:Cerebellum; D002547:Cerebral Palsy / Q000150:complications / Q000628:therapy*; D046690:Deep Brain Stimulation / Q000379:methods*; D020821:Dystonic Disorders / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000209:etiology / Q000628:therapy*; D010146:Pain; D010147:Pain Measurement; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Cerebellar neurostimulation; Cerebral palsy; Dystonia; Spasticity