Long-term functional outcome after selective posterior rhizotomy

2002 ◽  
Vol 97 (2) ◽  
pp. 315-325 ◽  
Author(s):  
Sandeep Mittal ◽  
Jean-Pierre Farmer ◽  
Borhan Al-Atassi ◽  
Joanne Gibis ◽  
Eileen Kennedy ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Functional Outcome ◽  
Motor Function ◽  
Lower Limb ◽  
Content Type ◽  
Limb Spasticity ◽  
Lower Limb Spasticity ◽  
Selective Posterior Rhizotomy ◽  
Fine Print

Object. Selective posterior rhizotomy (SPR) is a well-recognized treatment for children with spastic cerebral palsy (CP). Few investigators have used quantitative outcome measures to assess the surgical results beyond 3 years. The authors analyzed data obtained from the McGill Rhizotomy Database to determine the long-term functional outcome of children who had undergone selective dorsal rhizotomy accompanied by intraoperative electrophysiological monitoring. Methods. The study population was composed of children with spastic CP who underwent SPR and were evaluated by a multidisciplinary team preoperatively, and at 6 months and 1 year postoperatively. Quantitative standardized assessments of lower-limb spasticity, passive range of motion, muscle strength, and ambulatory function were obtained. Of the 93 patients who met the entry criteria for the study, 71 completed the 3-year and 50 completed the 5-year assessments, respectively. Statistical analysis demonstrated significant improvements in spasticity, range of motion, and functional muscle strength at 1 year after SPR. The preoperative, 1-, 3-, and 5-year values for the global score of the Gross Motor Function Measure were 64.6, 70.8, 80, and 85.6, respectively. The greatest improvement occurred in the dimensions reflecting lower-extremity motor function, where the mean change was 10.1% at 1 year, 19.9% at 3 years, and 34.4% at the 5-year follow-up review in comparison with the baseline value. This was associated with a lasting improvement in alignment and postural stability during developmental positions, as well as increased ability to perform difficult transitional movements. Conclusions. The results of this study support the presence of significant improvements in lower-limb functional motor outcome 1 year after SPR, and the improvements persist at 3 and 5 years. The authors conclude that SPR in conjunction with intraoperative stimulation is valuable for permanently alleviating lower-limb spasticity while augmenting motor function.

Relationship of intraoperative electrophysiological criteria to outcome after selective functional posterior rhizotomy

1995 ◽  
Vol 83 (1) ◽  
pp. 18-26 ◽  
Author(s):  
Paul Steinbok ◽  
Bengt Gustavsson ◽  
John R. W. Kestle ◽  
Ann Reiner ◽  
D. Doug Cochrane
Keyword(s):  
Lower Limb ◽  
Phase 2 ◽  
Nerve Roots ◽  
Phase 3 ◽  
Limb Function ◽  
Content Type ◽  
Limb Spasticity ◽  
Lower Limb Spasticity ◽  
Lower Limb Function ◽  
Fine Print

✓ At British Columbia's Children's Hospital, the criteria used in selective functional posterior rhizotomy (SFPR) evolved in three distinct phases. In Phase 1 the electrophysiological criteria for abnormality included a low threshold to a single stimulation, a sustained response to 50-Hz stimulation, and spread outside the segmental level being stimulated. In Phase 2 the electrophysiological criteria were unchanged, but fewer L3–4 nerve roots were cut. In Phase 3, fewer L3–4 nerve roots were cut, as in Phase 2, but based on the results of posterior nerve root stimulation in nonspastic controls, the only electrophysiological criterion used was contralateral and suprasegmental spread. The present study examined the relationship between the criteria used in each phase and patient outcome. The records of 77 consecutive children who underwent SFPR and had a minium follow-up period of 1 year were reviewed, comprising 25, 19, and 33 patients in Phases 1, 2, and 3, respectively. Outcome parameters included quantitative assessments of lower-limb spasticity and range of motion, and qualitative assessments of lower-limb function. In Phase 3, 52% of the nerve roots were cut, compared to 66% in Phases 1 and 2. In all three phases there was a significant decrease in lower-limb spasticity and an increase in range of movement, with the smallest decrease in spasticity in Phase 3. Over 90% of children in each phase improved with respect to lower-limb function, and excluding independent walkers and quadriplegics confined to a wheelchair, improvement in the level of ambulation occurred in 87.5%, 71.4%, and 73.7% of patients, in Phases 1, 2, and 3, respectively.

Long-term safety of repeated high doses of incobotulinumtoxinA injections for the treatment of upper and lower limb spasticity after stroke

2017 ◽  
Vol 378 ◽  
pp. 182-186 ◽  
Author(s):  
Andrea Santamato ◽  
Francesco Panza ◽  
Domenico Intiso ◽  
Alessio Baricich ◽  
Alessandro Picelli ◽  
...  
Keyword(s):  
Lower Limb ◽  
Limb Spasticity ◽  
Lower Limb Spasticity ◽  
High Doses

Functional performance following selective posterior rhizotomy: long-term results determined using a validated evaluative measure

2002 ◽  
Vol 97 (3) ◽  
pp. 510-518 ◽  
Author(s):  
Sandeep Mittal ◽  
Jean-Pierre Farmer ◽  
Borhan Al-Atassi ◽  
Kathleen Montpetit ◽  
Nathalie Gervais ◽  
...  
Keyword(s):  
Functional Performance ◽  
Self Care ◽  
Performance Outcomes ◽  
Long Term Results ◽  
Spastic Cerebral Palsy ◽  
Content Type ◽  
Dorsal Rhizotomy ◽  
Selective Posterior Rhizotomy ◽  
Fine Print

Object. Selective posterior rhizotomy (SPR) may result in considerable benefit for children with spastic cerebral palsy. To date, however, there have been few studies in which validated functional outcome measures have been used to report surgical results beyond 3 years. The authors analyzed data obtained from the McGill Rhizotomy Database to determine long-term functional performance outcomes in patients who underwent lumbosacral dorsal rhizotomy performed using intraoperative electrophysiological monitoring. Methods. The study population was composed of children with debilitating spasticity who underwent SPR and were evaluated by a multidisciplinary team preoperatively and at 6 months and 1 year postoperatively. Quantitative standardized assessments of activities of daily living (ADL) were obtained using the Pediatric Evaluation of Disability Inventory (PEDI). Of 57 patients who met the entry criteria for the study, 41 completed the 3-year assessments and 30 completed the 5-year assessments. Statistical analysis demonstrated significant improvement in the mobility and self-care domains of the functional skills dimension at 1 year after SPR. The preoperative and 1-, 3-, and 5-year postoperative scaled scores for the mobility domain were 56, 64, 77.2, and 77.8, respectively. The scaled score for the self-care domain increased from 59 presurgery to 67.9, 81.6, and 82.4 at the 1-, 3-, and 5-year postoperative assessments, respectively. Conclusions. The results of this study support the presence of significant improvements in functional performance, based on PEDI scores obtained 1 year after SPR. The improvements persisted at the 3- and 5-year follow-up examinations. The authors conclude that SPR performed using intraoperative stimulation is valuable in the augmentation of motor function and self-care skills essential to the performance of ADL.

Long-term benefits in quality of life provided by bilateral subthalamic stimulation in patients with Parkinson disease

2005 ◽  
Vol 103 (2) ◽  
pp. 252-255 ◽  
Author(s):  
Kelly E. Lyons ◽  
Rajesh Pahwa
Keyword(s):  
Quality Of Life ◽  
Parkinson Disease ◽  
Motor Function ◽  
Well Being ◽  
Strongly Correlated ◽  
Content Type ◽  
Fine Print

Object. The goals of this study were to evaluate long-term benefits in quality of life in patients with Parkinson disease (PD) after bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) and to evaluate the relationship between improvements in motor function and quality of life. Methods. Seventy-one patients who received bilateral STN stimulation implants and participated in follow-up review for at least 12 months were included in the study. Fifty-nine patients participated in a 12-month follow-up review and 43 patients in a follow-up review lasting at least 24 months. Patients' symptoms were assessed preoperatively by using the Unified PD Rating Scale (UPDRS) in the “medication-on” and “medication-off” conditions and quality of life was examined using the 39-item PD Questionnaire (PDQ-39). Patient evaluations were repeated postoperatively during periods of stimulation. The UPDRS activities of daily living (ADL) and motor scores as well as the PDQ-39 total, mobility, ADL, emotional well-being, stigma, and bodily discomfort scores were significantly improved at 12 months compared with baseline scores; the UPDRS ADL and motor scores as well as the PDQ-39 total, mobility, ADL, stigma, and bodily discomfort scores were significantly improved at the longest follow-up examination compared with baseline scores. There was a strong correlation between UPDRS motor and ADL scores and the PDQ-39 total, mobility, and ADL scores. Further analyses indicated that improvements in tremor were only correlated with PDQ-39 ADL subscale scores and rigidity was not correlated with any aspect of quality of life. Nevertheless, bradykinesia was strongly correlated with improvements in the PDQ-39 total, mobility, and ADL scores. Conclusions. Improvements in quality of life following bilateral DBS of the STN are maintained in the long term. These improvements are strongly correlated with improvements in motor function, primarily with regard to bradykinesia.

Long-term effect of tibial nerve neurotomy in stroke patients with lower limb spasticity

2009 ◽  
Vol 278 (1-2) ◽  
pp. 71-76 ◽  
Author(s):  
Marc Rousseaux ◽  
Nadia Buisset ◽  
Walter Daveluy ◽  
Odile Kozlowski ◽  
Serge Blond
Keyword(s):  
Lower Limb ◽  
Tibial Nerve ◽  
Term Effect ◽  
Stroke Patients ◽  
Long Term Effect ◽  
Limb Spasticity ◽  
Lower Limb Spasticity

Long-term safety and efficacy of incobotulinumtoxinA for lower- or combined upper- and lower-limb spasticity in children and adolescents with cerebral palsy

Toxicon ◽  
2018 ◽  
Vol 156 ◽  
pp. S56
Author(s):  
Petr Kaňovský ◽  
Florian Heinen ◽  
Sebastian Schroeder ◽  
Steffen Berweck ◽  
Henry G. Chambers ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Children And Adolescents ◽  
Lower Limb ◽  
Safety And Efficacy ◽  
Limb Spasticity ◽  
Lower Limb Spasticity

Surgery in adults with tethered cord syndrome: outcome study with independent clinical review

2001 ◽  
Vol 94 (2) ◽  
pp. 205-209 ◽  
Author(s):  
Redmer van Leeuwen ◽  
Nicolette C. Notermans ◽  
W. Peter Vandertop
Keyword(s):  
Muscle Strength ◽  
Motor Function ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Adult Patients ◽  
Sensory Function ◽  
Split Cord Malformation ◽  
Short Term ◽  
Content Type ◽  
Fine Print

Object. The authors conducted a study to evaluate the risks and short-term benefits of surgical treatment for tethered cord syndrome (TCS) in patients older than 18 years of age. Methods. The authors studied a series of 57 consecutive adult patients with TCS of varying origins. Patients were examined by the same neurologist in a standardized fashion before and after surgery, and most were followed for at least 2 years postoperatively. Patient age ranged from 19 to 75 years. The mean age at onset of symptoms and diagnosis was 30 years and 37 years, respectively. Muscle strength improved (15 cases) or showed no change postoperatively (38 cases) in a large majority of patients (93%). In four patients a minor decrease in muscle strength was demonstrated, and there was significant deterioration in two (3.5%). In the two latter patients, a rapid decline in motor function was present preoperatively. Subjective assessment of pain, gait, sensory function, and bladder/bowel function at 4 weeks, 6 months, and 2 years postsurgery revealed improvement in a substantial percentage of patients. No major surgery-related complications occurred. Conclusions. This is the largest series to date in which adult patients with TCS comprise the report. Untethering procedures in these patients were safe and effective, at least in the short term. Patients with rapid loss of motor function, lipomyelomeningocele, or split cord malformation seem to be at a higher risk of postsurgery deterioration. A follow-up period of many more years will be necessary to determine whether aggressive surgery is beneficial in the long term.

Functional outcome after surgical treatment of spontaneous and nonspontaneous spinal subdural hematomas

2005 ◽  
Vol 3 (1) ◽  
pp. 12-16 ◽  
Author(s):  
Ruth Thiex ◽  
Armin Thron ◽  
Joachim M. Gilsbach ◽  
Veit Rohde
Keyword(s):  
Functional Outcome ◽  
Symptom Onset ◽  
Neurological Deficits ◽  
Content Type ◽  
Sensorimotor Deficits ◽  
Subdural Hematomas ◽  
Long Term Survivors ◽  
Postoperative Improvement ◽  
Fine Print

Object. Because of the rarity of spinal subdural hematomas (SDHs), the literature offers scarce estimates of the outcome and predictive factors in patients suffering from these lesions. In addition, single-institution surgical series are still lacking. Therefore, the authors retrospectively evaluated the early and long-term functional outcomes measured in eight patients with spontaneous and nonspontaneous spinal SDHs in whom the clot had been evacuated. Methods. The patients' charts were evaluated for origin of the lesion, risk factors, and neurological deficits at symptom onset and at 28 days after extirpation of the spinal SDH. Long-term clinical outcome (Barthel Index [BI]) was evaluated by administering a telephone questionnaire to the patient or a relative. Only one patient with a spontaneous spinal SDH was identified. Four patients were undergoing anticoagulant therapy, and three patients had undergone a previous anesthetic/diagnostic spinal procedure. Twenty-eight days postoperatively, neurological deficits improved in six of eight patients; however, in two of the six patients, the improvement did not allow the patients to become independent again. In two patients, surgery did not affect the complete sensorimotor deficits. In the long-term survivors (median 45 months) a median BI of 55 was achieved. The latency between symptom onset and surgery did not correlate with functional outcome in this series. The preoperative neurological condition and location of the hematoma correlated positively with early and long-term functional outcome. Conclusions. To the best of their knowledge, the present study is the largest single-institutional study of patients with surgically treated spinal SDHs. Despite some postoperative improvement of sensorimotor deficits in most patients, the prognosis is poor because 50% of the patients remain dependent. Their outcome was determined by the preoperative sensorimotor function and spinal level of the spinal SDH.

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