Document Detail

The surgical management of spasticity.
MedLine Citation:
PMID:  11918648     Owner:  NLM     Status:  MEDLINE    
Neurosurgery is only considered for severe spasticity following the failure of noninvasive management (adequate medical and physical therapy). The patients are carefully selected, based on rigorous multidisciplinary clinical assessment. In this we evaluate the contribution of the spasticity to the disability and any residual voluntary motor function. The goals for each patient are: (a) improvement of function and autonomy; (b) control of pain; and (c) prevention of orthopaedic disorders. To achieve these objectives, the surgical procedure must be selective and reduce the excessive hypertonia without suppressing useful muscle tone and limb functions. The surgical procedures are: (1) Classical neuro-ablative techniques (peripheral neurotomies, dorsal rhizotomies) and their modern modifications using microsurgery and intra-operative neural stimulation (dorsal root entry zone: DREZotomy). These techniques are destructive and irreversible, with the reduced muscle tone reflecting the nerve topography. It is mainly indicated when patients have localized spasticity without useful mobility. (2) Conservative techniques based on a neurophysiological control mechanism. These procedures are totally reversible. The methods involve chronic neurostimulation of the spinal cord or the cerebellum. There are only a few patients for whom this is indicated. Conversely, chronic intrathecal administration of baclofen, using an implantable pump, is well established in the treatment of diffuse spasticity of spinal origin. From reports in the literature, we critically review the respective indications in terms of function, clinical progression and the topographic extent of the spasticity.
Y Lazorthes; J-C Sol; B Sallerin; J-C Verdié
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Publication Detail:
Type:  Comparative Study; Journal Article; Review    
Journal Detail:
Title:  European journal of neurology : the official journal of the European Federation of Neurological Societies     Volume:  9 Suppl 1     ISSN:  1351-5101     ISO Abbreviation:  Eur. J. Neurol.     Publication Date:  2002 May 
Date Detail:
Created Date:  2002-03-28     Completed Date:  2002-06-20     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9506311     Medline TA:  Eur J Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  35-41; dicussion 53-61     Citation Subset:  IM    
Department of Neurosurgery, CHU Rangueil-Larrey, University Paul Sabatier, Toulouse, France.
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MeSH Terms
Baclofen / administration & dosage,  therapeutic use
Electric Stimulation Therapy
Infusion Pumps
Muscle Relaxants, Central / administration & dosage,  therapeutic use
Muscle Spasticity / physiopathology,  surgery*,  therapy
Neurosurgical Procedures*
Peripheral Nerves / surgery
Rhizotomy / methods
Spinal Cord / physiopathology
Reg. No./Substance:
0/Muscle Relaxants, Central; 1134-47-0/Baclofen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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