Sudden falls as a persistent complication of selective dorsal rhizotomy surgery in children with bilateral spasticity: report of 3 cases.
Selective dorsal rhizotomy (SDR) surgery is a well-established treatment for ambulatory children with bilateral spastic paresis and is performed to eliminate spasticity and improve walking. The objective of this case report is to describe sudden falls as a persistent complication of SDR. The authors report on 3 patients with bilateral spastic paresis, aged 12, 6, and 7 years at the time of surgery. The percentage of transected dorsal rootlets was around 40% at the L2-S1 levels. Sudden falls were reported with a frequency of several a day, continuing for years after SDR. The falls were often triggered by performing dual tasks as well as occurring in the transition from sitting to standing, during running, after strenuous exercise, or following a fright. Patients also had residual hyperesthesia and dysesthesia of the foot sole. The authors hypothesize that the sudden falls are caused by a muscle inhibition reflex of the muscles in the legs, as an abnormal reaction to a sensory stimulus that is perceived with increased intensity by a patient with hyperesthesia. A favorable effect of gabapentin medication supports this hypothesis.
Departments of 1 Rehabilitation Medicine.
Laura R
LR
Grootveld
Departments of 1 Rehabilitation Medicine.|Physical Therapy.
Petra E M
PE
van Schie
Departments of 1 Rehabilitation Medicine.
Annemieke I
AI
Buizer
Department of Child Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.
R
R
Jeroen Vermeulen
Neurosurgery, and.
Willem J R
WJ
van Ouwerkerk
Clinical Neurophysiology, VU University Medical Center, Amsterdam; and.
Rob L M
RL
Strijers
Departments of 1 Rehabilitation Medicine.
Jules J G
JJ
Becher
D000058:Accidental Falls; D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000175:diagnosis* / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology*; D019051:Rhizotomy / Q000009:adverse effects* / Q000639:trends; D055815:Young Adult
BMI = body mass index; CP = cerebral palsy; GABA = gamma-aminobutyric acid; GMFCS = Gross Motor Function Classification System; GMFM-66 = Gross Motor Function Measure-66; HSP = hereditary spastic paraplegia; SDR = selective dorsal rhizotomy; bilateral spastic cerebral palsy; complication; functional neurosurgery; selective dorsal rhizotomy; sudden falls