Coupled obturator neurotomies and lidocaine intrathecal infusion to treat bilateral adductor spasticity and drug-refractory pain

2010 ◽  
Vol 113 (3) ◽  
pp. 528-531 ◽  
Author(s):  
José D. Carrillo-Ruiz ◽  
Pablo Andrade ◽  
Nora Godínez-Cubillos ◽  
María L. Montes-Castillo ◽  
Fiacro Jiménez ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Scale Score ◽  
Infusion Pump ◽  
Spastic Diplegia ◽  
Somatic Pain ◽  
Refractory Pain ◽  
Visual Analog Scales ◽  
Postoperative Control ◽  
History Of ◽  
Multiple Treatments

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.

scholarly journals Hereditary Spastic Paraplegia Mimicking Cerebral Palsy-Heterozygous Mutation in ALDH18A1

2021 ◽  
Author(s):  
Amit S Vatkar ◽  
Nisha Dolas ◽  
Vedashree Deshpande ◽  
Pallavi Wadhawan ◽  
Mumtaz Sharif
Keyword(s):  
Cerebral Palsy ◽  
Neurodegenerative Disorders ◽  
Birth Asphyxia ◽  
Lower Limbs ◽  
Heterozygous Mutation ◽  
Spastic Diplegia ◽  
Spastic Paraplegia ◽  
Hereditary Spastic Paraplegias ◽  
History Of ◽  
One Year

Spastic paraplegias are characterised by progressive rigidity and weakness of the lower limbs. Spastic paraplegia is a standard differential diagnosis for spastic diplegic cerebral palsy. Hereditary Spastic Paraplegias (HSP) are genetically and clinically heterogeneous group of neurodegenerative disorders causing paraplegias. Eighty forms of HSP have been noted and 64 genes have been identified. The Aldehyde Dehydrogenase 18 family member A1 (ALDH18A1) gene is located at 10q24.1 and it encodes delta-1-Pyrroline-5-Carboxylate Synthetase (P5CS), a mitochondrial bifunctional enzyme which is used for catalysing various amino acids. Mutations in this gene causes P5CS deficiency, which is responsible for neurodegenerative diseases. One should suspect neurometabolic conditions when no definite history of birth asphyxia is present in a case of cerebral palsy. Hereby, the authors report a case of a one-year-old male child with heterozygous mutation in ALDH18A1 gene resulting in spastic diplegia.

scholarly journals Clinical profile of cerebral palsy: a study from multidisciplinary clinic at tertiary care centre

2018 ◽  
Vol 5 (4) ◽  
pp. 1626
Author(s):  
Raj Kumar ◽  
Anand Kumar Gupta ◽  
Ritesh Runu ◽  
Sanjay Kumar Pandey ◽  
Manish Kumar
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Cross Sectional Study ◽  
Spastic Diplegia ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
History Of

Background: Cerebral Palsy (CP) is combined disorder of movement, posture, and motor function and may be associated sensory, neurological and musculoskeletal complications.  It is a permanent condition attributed to nonprogressive disturbances that occurred in the developing brain. The aim of this study is to Cerebral Palsy (CP) is combined disorder of movement, posture, and motor function and may be associated sensory, neurological and musculoskeletal complications.  It is a permanent condition attributed to nonprogressive disturbances that occurred in the developing brain.Methods: Retro prospective cross-sectional study done in super speciality tertiary care centre of East India. Total 70 Children enrolled in multidisciplinary CP clinic in Physical medicine and Rehabilitation (PMR) OPD between September 2017- March 2018.Results: 78.57%male and 21.42% female, all had hospital delivery with 78.5% had normal and 21.5% caesarean section. 70% had history of birth asphyxia and 61.5% required NICU admission. 61.4% had birth wt. less than 2 kg and 10% had birth wt. less than 1kg. One fourth cases had microcephaly and one third had history of seizures. Visual abnormalities, Hearing impairment and history of jaundice were found in about one sixth children. Spastic CP was the most common (76% cases) followed by Dyskinetic 10%, Hyponic and Ataxic (1%). In spastic CP Diplegia was most common (55%), followed by Quadriplegia 24%, Hemiplegia 19% and Monoplegia 2%. GMFCS score 5 was seen in 29% (mostly quadriplegic), followed by GMFCS level 1, 21.27% (mostly hemiplegic), others mostly diplegic in level 3(19%), level 2 and 4 (14%).Conclusions: Male CP are more reaching tertiary care centre in Bihar. Perinatal factors (asphyxia) were main etiological risk factor, and Spastic Diplegia is the most common type of CP. Disability need to be detected at the earliest to facilitate a timely and appropriate intervention like early rehabilitation, special education and psycho-social support.

scholarly journals Standardized Outcomes Measures in Physical Therapy Practice for Treatment and Rehabilitation of Cerebral PALSY: A Systematic Review

2021 ◽  
Vol 11 (7) ◽  
pp. 604
Author(s):  
Maria Dolores Apolo-Arenas ◽  
Aline Ferreira de Araújo Jerônimo ◽  
Alejandro Caña-Pino ◽  
Orlando Fernandes ◽  
Joana Alegrete ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Physical Therapy ◽  
Gait Training ◽  
Physical Therapy Modalities ◽  
Spastic Diplegia ◽  
Evaluation Procedures ◽  
Outcomes Measures ◽  
Prisma Statement ◽  
Spastic Hemiplegia

Cerebral palsy (CP) treatment includes physical therapy and various complementary therapies to the standard clinical treatment. However, there are not many reviews that focus on the methods used and evaluation procedures. This study aims to analyze which tools are most suitable for the evaluation and methodology of patients with CP treated with physical therapy. Following the PRISMA statement, through a PICOS strategy, PubMed/MEDLINE, Web of Science (WOS), Scopus, Science Direct, and Scielo were searched with the following terms: cerebral palsy AND (physical therapy modalities OR therapeutics) AND outcome assessment. The methodological quality of the RCTs was assessed with the Evidence Project risk of bias tool. Thirty-seven RCTs and six RCT protocols, comprising 1359 participants with different types of CP: spastic hemiplegia/paresis, spastic diplegia/paresis, and spastic CP, met the inclusion criteria, uncovering 21 variables measured through 77 different instruments and several interventions. The therapies most widely used in CP are gaming or technology-assisted therapies, aerobic training, hippotherapy, music therapy, gait training, and aquatic exercises. This study provides an overview of what the authors used in the neurorehabilitation field through procedure evaluation and checking the technological advance that began to be used.

The natural history of crouch gait in bilateral cerebral palsy: A systematic review

2018 ◽  
Vol 80 ◽  
pp. 84-92 ◽  
Author(s):  
Rory O’Sullivan ◽  
Frances Horgan ◽  
Tim O’Brien ◽  
Helen French
Keyword(s):  
Systematic Review ◽  
Cerebral Palsy ◽  
Natural History ◽  
Crouch Gait ◽  
History Of

scholarly journals Effects of Dynamic Elastomeric Fabric Orthoses on Children with Cerebral Palsy

2009 ◽  
Vol 33 (4) ◽  
pp. 339-347 ◽  
Author(s):  
Martin John Matthews ◽  
Martin Watson ◽  
Barbara Richardson
Keyword(s):  
Cerebral Palsy ◽  
Single Case ◽  
Phase 1 ◽  
Functional Mobility ◽  
Gait Velocity ◽  
Controlled Study ◽  
Patient Specific ◽  
Spastic Diplegia ◽  
Cost Index ◽  
Beneficial Effects

This phase 1 exploratory study aimed to establish proof of concept of the effects of dynamic elastomeric fabric orthoses (DEFOs) on the gait of children with spastic diplegic cerebral palsy. Replicated single case experiments employing an ABA methodology were carried out on eight subjects (median age 5.5 years, range 3–13 years; 4 girls/boys) utilizing quantitative/qualitative data collection. Outcome measures were: Ten metre walking test (10MWT); physiological cost index (PCI); visual analogue scale (VAS) scoring of perceived gait changes; functional mobility changes using Patient Specific Functional Scale (PSFS); subject/carer perceptions recorded in daily diaries. Results identified following analysis of quantitative data indicated a treatment effect from the orthoses which could be corroborated by participant subjective impressions and comments. Statistically significant ( p < 0.05) intervention-related improvements in gait velocity and gait consistency were identified respectively in 5/8 and 4/8 subjects. Power calculations support the feasibility of a larger controlled study to further investigate this orthotic intervention. This study indicates that DEFO leggings can confer beneficial effects on the gait of some children with spastic diplegia resulting from CP. These findings have implications for orthotic intervention with this subject group.

scholarly journals The Natural History of Cerebral Palsy

1989 ◽  
Vol 64 (3) ◽  
pp. 436-436
Author(s):  
L Rosenbloom
Keyword(s):  
Cerebral Palsy ◽  
Natural History ◽  
History Of

Discontinuation of Antiepileptic Drug Treatment After Two Seizure-free Years in Children With Cerebral Palsy

PEDIATRICS ◽  
1996 ◽  
Vol 97 (2) ◽  
pp. 192-197
Author(s):  
Mauricio R. Delgado ◽  
Anthony R. Riela ◽  
Janith Mills ◽  
Alan Pitt ◽  
Richard Browne
Keyword(s):  
Cerebral Palsy ◽  
Mental Retardation ◽  
Antiepileptic Drug ◽  
Spastic Diplegia ◽  
Multiple Factors ◽  
Spastic Hemiparesis ◽  
Children With Cerebral Palsy ◽  
Epileptic Children ◽  
Seizure Relapse ◽  
Antiepileptic Drug Treatment

Objective. The risk of seizure relapse after antiepileptic drug (AED) discontinuation in children has been reported to vary between 6% and 40%. It has been suggested that neurologic deficit and mental retardation are poor prognostic factors for seizure relapse after AED discontinuation. Because epileptic children with cerebral palsy (CP) have neurologic deficits, and many have mental retardation, it is important to know their risk for seizure relapse. Methods. AED treatment was discontinued in 65 children with CP and histories of epilepsy after 2 seizure-free years. All of the patients were followed until they had seizure relapses or for at least 2 years without seizures after AEDs were stopped. Multiple factors were analyzed for possible association with seizure relapse. Results. Twenty-seven patients (41.5%) had seizure relapses. Patients with spastic hemiparesis had the highest relapse rate (61.5%), and those with spastic diplegia had the lowest rate (14.3%). No other factor correlated significantly with the risk of seizure relapse. Conclusions. Discontinuation of AEDs in children with CP can, and should, be practiced when possible after patients have been seizure-free for at least 2 years. AED discontinuation in patients with spastic hemiparesis is significantly more likely to lead to seizure relapse than in patients with other CP types, but no other factor is yet known to increase the chance of relapse.

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