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Vorobyev AN, Burmistrova AV, Puzin KM, Varyukhina MD, Radutnaya ML, Yakovlev AA, Chmutin GE, Musa G, Chmutin EG, Grechko AV, Reyes Soto G, Catillo-Rangel C, Nurmukhametov R, Ramirez MDJE, Montemurro N. Clinical Outcome After Epidural Spinal Cord Stimulation in Patients With Severe Traumatic Brain Injury. Cureus 2024; 16:e65753. [PMID: 39211655 PMCID: PMC11361623 DOI: 10.7759/cureus.65753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Epidural spinal cord stimulation is a minimally invasive procedure with a growing list of indications. It has a good safety profile and analgesic effect, reduces the severity of spasticity, and activates various brain regions. The purpose of this study is to evaluate the clinical outcome of epidural spinal cord stimulation in patients with spastic syndrome and chronic disorders of consciousness resulting from severe traumatic brain injury (sTBI). METHODS Between 2021 and 2023, an epidural spinal cord stimulation test was performed in 34 patients with central paresis, severe hypertonia, and chronically altered consciousness following sTBI. The severity of spastic syndrome was assessed using a modified Ashworth scale. All patients underwent implantation of a cylindrical eight-contact test epidural electrode at C3-C5 cervical level, followed by neurostimulation and selection of individual modes. Tonic stimulation at a frequency of 60 Hz, "burst" mode, or a combination of the two was used. RESULTS Epidural spinal cord stimulation was administered for an average of 4 ± 1.5 days, with tonic stimulation mode applied in 15 (44.1%) patients, "burst" mode in 10 (29.4%), and a combination of two in nine (26.5%) patients. A reduction in spasticity with clinical improvement was observed in 21 patients (61.8%). The Ashworth scale scores for distal and proximal upper extremities decreased from 3 points to 2.5 points and from 3 points to 2 points, respectively. This was significant in the right upper limbs (p = 0.0152 distally and p = 0.0164 proximally). Significant improvements were also seen in the lower extremities. Active movements in paretic limbs increased or appeared in 12 patients (35.3%), while a heightened level of consciousness was observed in six patients (17.6%). Permanent neurostimulator implantation was performed in 12 patients (35.3%), with no reported surgical complications. CONCLUSION Epidural spinal cord stimulation shows promise as an invasive rehabilitation method for patients with sTBI sequelae. Its use reduced the severity of spastic syndrome in over half of patients and increased active movements in paretic limbs in over a third. Notably, neuromodulation at the cervical level yielded pronounced effects on the upper extremities, both proximally and distally. Findings regarding consciousness level improvement are particularly intriguing but warrant further validation through randomized trials.
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Affiliation(s)
- Alexey N Vorobyev
- Reanimatology and Rehabilitation, Federal Scientific and Clinical Center for Reanimatology and Rehabilitation, Moscow, RUS
| | - Aleksandra V Burmistrova
- Reanimatology and Rehabilitation, Federal Scientific and Clinical Center for Reanimatology and Rehabilitation, Moscow, RUS
| | - Kiril M Puzin
- Reanimatology and Rehabilitation, Federal Scientific and Clinical Center for Reanimatology and Rehabilitation, Moscow, RUS
| | - Maria D Varyukhina
- Reanimatology and Rehabilitation, Federal Scientific and Clinical Center for Reanimatology and Rehabilitation, Moscow, RUS
| | - Margarita L Radutnaya
- Reanimatology and Rehabilitation, Federal Scientific and Clinical Center for Reanimatology and Rehabilitation, Moscow, RUS
| | - Alexey A Yakovlev
- Reanimatology and Rehabilitation, Federal Scientific and Clinical Center for Reanimatology and Rehabilitation, Moscow, RUS
| | - Gennady E Chmutin
- Neurological Surgery, Peoples' Friendship University of Russia, Moscow, RUS
| | - Gerald Musa
- Neurosurgery, Livingstone Central Hospital, Livingstone, ZMB
- Neurosurgery, Peoples' Friendship University of Russia, Moscow, RUS
| | - Egor G Chmutin
- Nervous Diseases and Neurosurgery, Peoples' Friendship University of Russia, Moscow, RUS
| | - Andrey V Grechko
- Reanimatology and Rehabilitation, Federal Scientific and Clinical Center for Reanimatology and Rehabilitation, Moscow, RUS
| | | | | | | | | | - Nicola Montemurro
- Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP) University of Pisa, Pisa, ITA
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Bing J, You H, Dai Y, Ding Y. Progress and research trends in neurogenic bladder after spinal cord injury bibliometric analysis based on web of science database: An observational study. Medicine (Baltimore) 2024; 103:e38491. [PMID: 38875432 PMCID: PMC11175955 DOI: 10.1097/md.0000000000038491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 06/16/2024] Open
Abstract
Neurogenic bladder (NB) is a significant complication that often occurs after spinal cord injury. It results from urinary dysfunction caused by the injury, disrupting the normal neural control of the bladder and urethra. Symptoms of NB can include urinary frequency, urgency, incontinence, and retention, all of which can greatly impact the quality of life of affected individuals. While there are articles and reviews on NB, fewer specifically address NB following spinal cord injury. This study examined 1095 publications from January 1, 2000, to March 27, 2024, in the Web of Science core database using bibliometric software like VOSviewer, CiteSpace, and Bibliometrics. The analysis revealed an increasing trend in the number of publications, with the United States and China leading in research output. Professor Jeremy B. Myers from the University of Utah had the highest number of publications, while the University of Michigan and the University of Pittsburgh were the institutions with the most publications. The journal Neurourology and Urodynamics had the highest number of articles, and common keywords included management, quality of life, and dysfunction, highlighting key areas of focus for scholars.
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Affiliation(s)
- Jingyu Bing
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong
| | - Haihua You
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong
| | - Yaowen Dai
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong
| | - Yunxia Ding
- Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong
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Inotani T, Horaguchi A, Morishita Y, Yoshida A, Otomo M, Suzuki M, Inui T, Okubo Y, Komatsu S, Mizuno C, Takahashi Y, Ochiai T, Kinjo T, Asato T, Takayama J, Tamiya G, Saijo N, Kikuchi A, Haginoya K. Treatment of ZC4H2 Variant-Associated Spastic Paraplegia with Selective Dorsal Rhizotomy and Intensive Postoperative Rehabilitation: A Case Report. TOHOKU J EXP MED 2024; 262:239-244. [PMID: 38267061 DOI: 10.1620/tjem.2024.j004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Selective dorsal rhizotomy (SDR) has been used to treat children with spastic cerebral palsy (CP), and its beneficial effect on quality of life and ambulation has been confirmed in long-term follow-up studies. However, the role of SDR in the treatment of spasticity in patients with hereditary spastic paraplegia (HSP) and related disorders is not well-established. Here, we report the first patient with the ZC4H2 variant who underwent SDR to treat spastic paraplegia. Abnormal gait was discovered during a regular checkup at the age of 3 years and 9 months, and she was diagnosed with spastic paraplegia. She was heterozygous for the ZC4H2 variant and underwent SDR at the age of 5 years and 11 months, which alleviated the spasticity. The patient underwent inpatient postoperative rehabilitation for 4 months and continued outpatient physiotherapy after discharge. The Gross Motor Function Measure-88 score and maximum walking speed decreased transiently 1 month postoperatively, but gradually recovered, and continuously improved 6 months postoperatively. SDR and postoperative intensive rehabilitation were effective in improving motor and walking functions up to 6 months after surgery, although long-term follow-up is needed to draw conclusions.
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Affiliation(s)
- Toshiki Inotani
- Department of Rehabilitation and Developmental Support, Miyagi Children's Hospital
| | - Akira Horaguchi
- Department of Rehabilitation and Developmental Support, Miyagi Children's Hospital
| | - Yuko Morishita
- Department of Rehabilitation and Developmental Support, Miyagi Children's Hospital
| | - Ayuko Yoshida
- Department of Rehabilitation and Developmental Support, Miyagi Children's Hospital
| | - Misaki Otomo
- Department of Rehabilitation and Developmental Support, Miyagi Children's Hospital
| | - Makoto Suzuki
- Graduate School of Health and Environment Sciences, Tohoku Bunka Gakuen University
| | - Takehiko Inui
- Department of Pediatric Neurology, Miyagi Children's Hospital
| | - Yukimune Okubo
- Department of Pediatric Neurology, Miyagi Children's Hospital
| | - Shigemasa Komatsu
- Department of Pediatric Orthopedic Surgery and Rehabilitation, Miyagi Children's Hospital
| | - Chika Mizuno
- Department of Pediatric Orthopedic Surgery and Rehabilitation, Miyagi Children's Hospital
| | - Yuko Takahashi
- Department of Pediatric Orthopedic Surgery and Rehabilitation, Miyagi Children's Hospital
| | - Tatsuhiro Ochiai
- Department of Pediatric Orthopedic Surgery and Rehabilitation, Miyagi Children's Hospital
| | - Takeshi Kinjo
- Department of Orthopedic Surgery and Rehabilitation, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center
| | - Takashi Asato
- Department of Orthopedic Surgery and Rehabilitation, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center
| | - Jun Takayama
- Department of AI and Innovative Medicine, Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
- Statistical Genetics Team, RIKEN Center for Advanced Intelligence Project
- Department of Rare Disease Genomics, Tohoku University Graduate School of Medicine
| | - Gen Tamiya
- Department of AI and Innovative Medicine, Tohoku University Graduate School of Medicine
- Tohoku Medical Megabank Organization, Tohoku University
- Statistical Genetics Team, RIKEN Center for Advanced Intelligence Project
- Department of Rare Disease Genomics, Tohoku University Graduate School of Medicine
| | - Naoya Saijo
- Department of Pediatrics, Tohoku University School of Medicine
| | - Atsuo Kikuchi
- Department of Pediatrics, Tohoku University School of Medicine
- Department of Rare Disease Genomics, Tohoku University Graduate School of Medicine
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van de Pol LA, Burgert N, van Schie PEM, Slot KM, Gouw AA, Buizer AI. Surgical treatment options for spasticity in children and adolescents with hereditary spastic paraplegia. Childs Nerv Syst 2024; 40:855-861. [PMID: 37783799 PMCID: PMC10891194 DOI: 10.1007/s00381-023-06159-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/15/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To provide an overview of outcome and complications of selective dorsal rhizotomy (SDR) and intrathecal baclofen pump implantation (ITB) for spasticity treatment in children with hereditary spastic paraplegia (HSP). METHODS Retrospective study including children with HSP and SDR or ITB. Gross motor function measure (GMFM-66) scores and level of spasticity were assessed. RESULTS Ten patients were included (most had mutations in ATL1 (n = 4) or SPAST (n = 3) genes). Four walked without and two with walking aids, four were non-walking children. Six patients underwent SDR, three patients ITB, and one both. Mean age at surgery was 8.9 ± 4.5 years with a mean follow-up of 3.4 ± 2.2 years. Five of the SDR patients were walking. Postoperatively spasticity in the legs was reduced in all patients. The change in GMFM-66 score was + 8.0 (0-19.7 min-max). The three ITB patients treated (SPAST (n = 2) and PNPLA6 (n = 1) gene mutation) were children with a progressive disease course. No complications of surgery occurred. CONCLUSIONS SDR is a feasible treatment option in carefully selected children with HSP, especially in walking patients. The majority of patients benefit with respect to gross motor function, complication risk is low. ITB was used in children with severe and progressive disease.
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Affiliation(s)
- Laura A van de Pol
- Department of Child Neurology, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands.
- Emma Children's Hospital, Amsterdam UMC, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Nina Burgert
- Department of Rehabilitation Medicine, Amsterdam, UMC , Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Petra E M van Schie
- Department of Rehabilitation Medicine, Amsterdam, UMC , Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - K Mariam Slot
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Alida A Gouw
- Department of Neurology & Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Emma Children's Hospital, Amsterdam UMC, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam, UMC , Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
- Rehabilitation and Development, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Abstract
PURPOSE To review the neurosurgical treatments of children with movement disorders associated with cerebral palsy (CP) during the previous decades, up to the present day. METHODS An extensive literature review was undertaken to identify important publications about this subject. My experience treating children with these disorders over the past three decades was included in the individual sections. RESULTS Peripheral neurotomies have been developed for children with focal spasticity. For those with spastic paraparesis, selective lumbar rhizotomies were developed, and for those with spastic quadriparesis, intrathecal baclofen infusions were developed. Both effectively alleviate spasticity in the affected extremities. Generalized dystonia associated with CP has been treated with deep brain stimulation with mild improvement, but treatment with intrathecal baclofen and intraventricular baclofen improve those movements markedly. No effective treatment has been reported for children with athetoid CP. For those with choreiform CP, deep brain stimulation may be effective but intrathecal baclofen does not appear to be. CONCLUSION Treatment of children with movement disorders associated with CP increased slowly in the 1970s and 1980s but accelerated rapidly in the 1990s with the introduction of lumbar dorsal rhizotomies and intrathecal baclofen. In the last 30 years, tens of thousands of children with spasticity and movement disorders associated with CP have been treated by pediatric neurosurgeons, and their care has become an integral component of current pediatric neurosurgical practice.
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Lumsden DE. Neurosurgical management of elevated tone in childhood: interventions, indications and uncertainties. Arch Dis Child 2023; 108:703-708. [PMID: 36690424 DOI: 10.1136/archdischild-2020-320907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/15/2022] [Indexed: 01/25/2023]
Abstract
Elevated tone (hypertonia) is a common problem in children with physical disabilities. Medications intended to reduce tone often have limited efficacy, with use further limited by a significant side effect profile. Consequently, there has been growing interest in the application of Neurosurgical Interventions for the Management of Posture and Tone (NIMPTs). Three main procedures are now commonly used: selective dorsal rhizotomy (SDR), intrathecal baclofen (ITB) and deep brain stimulation (DBS). This review compares these interventions, along with discussion on the potential role of lesioning surgery. These interventions variably target spasticity and dystonia, acting at different points in the distributed motor network. SDR, an intervention for reducing spasticity, is most widely used in carefully selected ambulant children with cerebral palsy. ITB is more commonly used for children with more severe disability, typically non-ambulant, and can improve both dystonia and spasticity. DBS is an intervention which may improve dystonia. In children with certain forms of genetic dystonia DBS may dramatically improve dystonia. For other causes of dystonia, and in particular dystonia due to acquired brain injury, improvements following surgery are more modest and variable. These three interventions vary in terms of their side-effect profile and reversibility. There are currently populations of children for who it is unclear which intervention should be considered (SDR vs ITB, or ITB vs DBS). Concerns have been raised as to the equity of access to NIMPTs for children across the UK, and whether the number of surgeries performed each year meets the clinical need.
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Affiliation(s)
- Daniel E Lumsden
- Children's Neurosciences, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Sindou M, Joud A, Georgoulis G. How I do it: Selective dorsal rhizotomy, using interlaminar approaches, for spastic diplegia/quadriplegia in children with cerebral palsy. Acta Neurochir (Wien) 2021; 163:2845-2851. [PMID: 33624116 DOI: 10.1007/s00701-021-04770-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/11/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Dorsal rhizotomy is considered the gold standard for treating spastic diplegia/quadriplegia in children with cerebral palsy, when rehabilitation programs reveal insufficient to control excess of spasticity. METHOD The Keyhole Interlaminar Dorsal rhizotomy modality has been developed to access-individually-all L2-S2 roots, intradurally at the corresponding dural sheath, and preserve the posterior spine architecture. Intraoperative neuromonitoring consists of stimulating each ventral root, to verify its myotomal innervation, and dorsal roots, to explore their reflexive muscular responses in order to help determination of the proportion of rootlets to be cut. CONCLUSION This modality, which requires 5 ± 1 h duration, offers tailored accuracy.
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Agrawal M, Samala R, Doddamani RS, Chandra PS. Letter: predictors of postoperative complications after selective dorsal rhizotomy. Acta Neurochir (Wien) 2021; 163:475. [PMID: 33111153 DOI: 10.1007/s00701-020-04629-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/22/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Room No. 716, Neurosciences Centre, New Delhi, 110029, India
| | - Raghu Samala
- Department of Neurosurgery, All India Institute of Medical Sciences, Room No. 716, Neurosciences Centre, New Delhi, 110029, India
| | - Ramesh Sharanappa Doddamani
- Department of Neurosurgery, All India Institute of Medical Sciences, Room No. 716, Neurosciences Centre, New Delhi, 110029, India.
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, Room No. 716, Neurosciences Centre, New Delhi, 110029, India
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Agrawal M, Garg K, Mishra S, Doddamani R, Sarat Chandra P. Letter to the editor regarding "Selective dorsal rhizotomy for spasticity of genetic etiology". Childs Nerv Syst 2020; 36:1825. [PMID: 32617709 DOI: 10.1007/s00381-020-04787-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ramesh Doddamani
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, 110029, India
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