Article
Suprasegmental effects of selective posterior rhizotomy
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Authors
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D. Hořínek
- Department of Pediatric Neurosurgery, University Hospital Motol, Prague, Czech Republic
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M. Tichý
- Department of Pediatric Neurosurgery, University Hospital Motol, Prague, Czech Republic
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M. Zedka
- Department of Pediatric Neurology, University Hospital Motol, Prague, Czech Republic
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J. Vokřál
- Department of Neurology, University Hospital Motol, Prague, Czech Republic
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R. Černý
- Department of Phoniatrics, General University Hospital, Prague, Czech Republic
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D. Hoza
- Department of Pediatric Neurosurgery, University Hospital Motol, Prague, Czech Republic
| Published: | May 4, 2005 |
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Outline
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Objective
The aim of this study is to document in an objective manner the suprasegmental effects of selective posterior rhizotomy, such as the decrease of spasticity in upper limbs, the improvement of speech fluency, the reduction of congenital nystagmus, the improvement of poursuit movements and the changes in cortical response to transcranial magnetic stimulation.
Methods
Since 2001 21 selective posterior rhizotomies were performed in cerebral palsy patients affected by severe spasticity. The general locomotion level was measured by Peacock scale of locomotion and the severity of spasticity by Ashworth scale of muscle tone in all subjects. An acoustic analysis using the Multi-dimensional voice program was performed. Jitter, shimmer and noise-to-harmonic ratio were the acoustic parameters assessed in 10 children. The videooculography was performed in 10 patients. A qualitative analysis of poursuit movements, spontaneous nystagmus, gaze direction nystagmus, saccadic and fixation movements was carried out. Transcranial magnetic stimulation was performed in 7 patients and motor evoked potentials were recorded. All investigations were carried out pre- and postoperatively.
Results
The motor handicap was severe in most of the subjects (Peacock 3,2±1,17) and has not changed postoperatively when considering the average for the whole group (2,9±0,9). A significant decrease of spasticity in elbow flexor measured by Ashworth scale was observed (p<0,01) 6 months postoperatively. We observed the decrease in jitter in 5 patients, in whom the improvement of speech quality was also reported by their caregivers. In 4 patients a decrease in saccades intrusions and nystagmus jerks were noticed. The children in whom the improvement of speech and poursuit movements quality were observed were more severely impaired with spasticity than their counterparts in whom no such changes have been recorded.
Conclusions
Perinatal damage to the central nervous system in cerebral palsy leads to various and individual pathological reflex responses both on segmental and polysegmental levels. Selective posterior rhizotomy as a routine neurosurgical treatment for spasticity in pediatric population may decrease pathological reflex response on suprasegmental level, including brainstem and cerebral motor cortex responses.
This study has been supported by IGA grant NR/8318–3.
