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van der Veldt N, van Rappard DF, van de Pol LA, van der Knaap MS, van Ouwerkerk WJR, Becher JG, Wolf NI, Buizer AI. Intrathecal baclofen in metachromatic leukodystrophy. Dev Med Child Neurol 2019; 61:232-235. [PMID: 29806077 PMCID: PMC7379712 DOI: 10.1111/dmcn.13919] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 01/30/2023]
Abstract
Metachromatic leukodystrophy (MLD) is a rare progressive neurological disorder, often accompanied by motor impairments that are challenging to treat. In this case series, we report the course of treatment with intrathecal baclofen (ITB), aimed at improving daily care and comfort in children and young adults with MLD. All patients with MLD in our centre on ITB treatment for a minimum of 6 months were included (n=10; 4 males, 6 females; mean age 10y 8mo [range 6-24y]). Eight patients had MLD with a predominant spastic movement disorder (sMLD) and two were mainly dyskinetic. Patients with sMLD were compared with matched patients with spastic cerebral palsy (CP). Complication rates related to ITB treatment were similar in both groups. ITB treatment course in the first 6 months after pump implantation appears to show more dose increase in most patients MLD, compared to patients with spastic CP. This may be due to the progressive disease in MLD. ITB is a feasible therapy to improve daily care and comfort in patients with MLD and should therefore be considered early. WHAT THIS PAPER ADDS: Intrathecal baclofen (ITB) is a feasible therapy to improve comfort and daily care in children and young people with metachromatic leukodystrophy (MLD). In the first 6 months of ITB treatment, MLD seems to show more dose increase compared to spastic cerebral palsy.
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Affiliation(s)
- Nikki van der Veldt
- Department of Rehabilitation MedicineVU University Medical CenterAmsterdam Movement SciencesAmsterdamthe Netherlands
| | - Diane F van Rappard
- Department of Child NeurologyCenter for Childhood White Matter DisordersVU University Medical Center and Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Laura A van de Pol
- Department of Child NeurologyCenter for Childhood White Matter DisordersVU University Medical Center and Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Marjo S van der Knaap
- Department of Child NeurologyCenter for Childhood White Matter DisordersVU University Medical Center and Amsterdam NeuroscienceAmsterdamthe Netherlands
| | | | - Jules G Becher
- Department of Rehabilitation MedicineVU University Medical CenterAmsterdam Movement SciencesAmsterdamthe Netherlands
| | - Nicole I Wolf
- Department of Child NeurologyCenter for Childhood White Matter DisordersVU University Medical Center and Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation MedicineVU University Medical CenterAmsterdam Movement SciencesAmsterdamthe Netherlands
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Romei M, Oudenhoven LM, van Schie PEM, van Ouwerkerk WJR, van der Krogt MM, Buizer AI. Evolution of gait in adolescents and young adults with spastic diplegia after selective dorsal rhizotomy in childhood: A 10 year follow-up study. Gait Posture 2018; 64:108-113. [PMID: 29894977 DOI: 10.1016/j.gaitpost.2018.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/20/2018] [Accepted: 06/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Short-term benefit on gait of selective dorsal rhizotomy (SDR) surgery, which relieves spasticity of the lower extremities has been demonstrated in children with cerebral palsy (CP). However very little is known of the evolution of gait when patients become adolescents and young adults. RESEARCH QUESTION How does the gait pattern evolve in adolescents and young adults who underwent SDR during childhood? METHODS A longitudinal study was performed including 19 ambulant patients with spastic diplegia due to CP or other causes (mean age at SDR: 6.6 ± 1.6 years) who were assessed four times: pre-SDR, 2 years post- SDR, 5 years post-SDR and at least 10 years post-SDR. From 2D video recordings, Edinburgh Visual Gait Score and lower limb joint kinematic parameters were calculated. RESULTS Our data show that the improvement in the gait pattern obtained short-term after SDR continues during into adolescence and adulthood. Ten years after SDR all patients improved compared to baseline. Considering the lower limb joint kinematics, most notable improvements were found at knee and ankle joints. Compared to the evaluation before SDR, the range of motion of the knee increased: the knee was more extended at initial contact and knee flexion in midswing improved. Excessive ankle plantar flexion was reduced during the entire gait cycle. Only minor changes were found at hip and pelvis. Eight patients underwent additional orthopaedic surgery in the years after SDR, and the present findings should be considered as a combination of SDR, development and additional treatment. SIGNIFICANCE We demonstrate lasting improvement of gait quality in ambulant patients with spastic diplegia who underwent SDR during childhood when they become adolescents and young adults.
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Affiliation(s)
- Marianna Romei
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | - Laura M Oudenhoven
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | - Petra E M van Schie
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | | | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
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Gmeiner M, Wagner H, van Ouwerkerk WJR, Senker W, Holl K, Gruber A. Abdominal Pseudocysts and Peritoneal Catheter Revisions: Surgical Long-Term Results in Pediatric Hydrocephalus. World Neurosurg 2018; 111:e912-e920. [PMID: 29325961 DOI: 10.1016/j.wneu.2018.01.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/02/2018] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE An abdominal pseudocyst (APC) is a distal catheter site-specific failure in patients treated with ventriculoperitoneal shunts. Few studies with more than 10 patients have been reported. The aim of this study was to analyze causes of peritoneal catheter revisions with special emphasis on revisions because of an APC. METHODS Pediatric patients with first shunt operation between 1982 and 1992 were included, and time, cause, and modality of peritoneal catheter revision were determined retrospectively. RESULTS One hundred thirty-eight patients were treated for hydrocephalus, and 112 patients received a peritoneal catheter during the follow-up. An APC was diagnosed in 14 (12.5%) patients, and 28 revisions were needed for its treatment. The rate of shunt infection in patients with APC was 50%, but bacterial examination of the pseudofluid culture revealed infection in only 3 patients. Age at first surgical procedure, type of first surgical procedure, and etiology of hydrocephalus were not associated with APC diagnosis. APC recurred in 4 patients. These patients had a catheter repositioning directly into the peritoneum as first surgical treatment. No recurrences were observed in patients with shunt externalization or replacement of the peritoneal catheter. CONCLUSIONS An APC is a major long-term complication after ventriculoperitoneal shunt treatment. Although a sterile inflammatory response cannot be excluded completely, our results favor the hypothesis of low-level shunt infection. In both cases, the surgical consequences are the same. An infected APC should be treated as a shunt infection. Uninfected patients can be treated with shunt externalization and replacement of only the peritoneal catheter.
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Affiliation(s)
- Matthias Gmeiner
- Kepler University Hospital, Department of Neurosurgery, Linz, Austria.
| | - Helga Wagner
- Department of Applied Statistics, Johannes Kepler University, Linz, Austria
| | - Willem J R van Ouwerkerk
- Department of Neurosurgery, Vrije Universitet University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Wolfgang Senker
- Kepler University Hospital, Department of Neurosurgery, Linz, Austria
| | - Kurt Holl
- Kepler University Hospital, Department of Neurosurgery, Linz, Austria
| | - Andreas Gruber
- Kepler University Hospital, Department of Neurosurgery, Linz, Austria
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Gmeiner M, Wagner H, Zacherl C, Polanski P, Auer C, van Ouwerkerk WJR, Holl K. Long-term mortality rates in pediatric hydrocephalus-a retrospective single-center study. Childs Nerv Syst 2017; 33:101-109. [PMID: 27766469 DOI: 10.1007/s00381-016-3268-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 10/05/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Very long-term follow-up and outcome are rare for pediatric patients with hydrocephalus and shunt operations. The aim of this study was to determine the long-term mortality rates in these patients. METHODS Pediatric patients with first shunt operation between 1982 and 1992 were included. For each patient, time and cause of death were determined. Further, patients with first operation from 1982 to 1987 were compared to those first operated from 1988 to 1992. RESULTS One-hundred thirty-seven patients were included. Etiologies of hydrocephalus were intraventricular hemorrhage (31.4 %), meningomyelocele (25.5 %), postinfectious (11.7 %), congenital (10.2 %), posterior fossa cyst (8.8 %), aqueductal stenosis (8 %), and others (4.4 %). Overall, 53 patients (38.7 %) died. The percentage of patients surviving 1, 2, 10, and 20 years after first operation were 82.6, 73.6, 69.4, and 65.3 %, respectively. In 23 patients, the cause of death was related to shunt treatment: shunt infection was diagnosed in 18 and acute shunt dysfunction in 5 patients. Mortality was considerably higher for patients with their first operation in time period 1982-1987 compared to time period 1988-1992 (51 versus 25 %). The reduction of mortality was mainly due to an increased survival after shunt infection. Eighty-seven patients survived more than 20 years after initial shunt operation. Of those long-term survivors, three (3.4 %) patients died 22-24 years after first operation. CONCLUSION Mortality in hydrocephalic pediatric patients is high especially in the first postoperative years but is even significant in adult patients with pediatric hydrocephalus. As deaths occur even after 20 years, routine follow-up of long-term survivors remains necessary.
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Affiliation(s)
- Matthias Gmeiner
- Division of Neurosurgery, Kepler-Universitätsklinikum Linz, Wagner-Jauregg-Weg 15A, 4020, Linz, Austria.
| | - Helga Wagner
- Department of Applied Statistics, Johannes Kepler University, Linz, Austria
| | - Christoph Zacherl
- Division of Neurosurgery, Kepler-Universitätsklinikum Linz, Wagner-Jauregg-Weg 15A, 4020, Linz, Austria
| | - Petra Polanski
- Department of Pediatric Surgery, Children's Hospital, Linz, Austria
| | - Christian Auer
- Division of Neurosurgery, Kepler-Universitätsklinikum Linz, Wagner-Jauregg-Weg 15A, 4020, Linz, Austria
| | - Willem J R van Ouwerkerk
- Department of Neurosurgery, Vrije Universitet University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Kurt Holl
- Division of Neurosurgery, Kepler-Universitätsklinikum Linz, Wagner-Jauregg-Weg 15A, 4020, Linz, Austria
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Grootveld LR, van Schie PEM, Buizer AI, Jeroen Vermeulen R, van Ouwerkerk WJR, Strijers RLM, Becher JJG. Sudden falls as a persistent complication of selective dorsal rhizotomy surgery in children with bilateral spasticity: report of 3 cases. J Neurosurg Pediatr 2016; 18:192-5. [PMID: 27104630 DOI: 10.3171/2016.2.peds15527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Selective dorsal rhizotomy (SDR) surgery is a well-established treatment for ambulatory children with bilateral spastic paresis and is performed to eliminate spasticity and improve walking. The objective of this case report is to describe sudden falls as a persistent complication of SDR. The authors report on 3 patients with bilateral spastic paresis, aged 12, 6, and 7 years at the time of surgery. The percentage of transected dorsal rootlets was around 40% at the L2-S1 levels. Sudden falls were reported with a frequency of several a day, continuing for years after SDR. The falls were often triggered by performing dual tasks as well as occurring in the transition from sitting to standing, during running, after strenuous exercise, or following a fright. Patients also had residual hyperesthesia and dysesthesia of the foot sole. The authors hypothesize that the sudden falls are caused by a muscle inhibition reflex of the muscles in the legs, as an abnormal reaction to a sensory stimulus that is perceived with increased intensity by a patient with hyperesthesia. A favorable effect of gabapentin medication supports this hypothesis.
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Affiliation(s)
| | | | | | - R Jeroen Vermeulen
- Department of Child Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Rob L M Strijers
- Clinical Neurophysiology, VU University Medical Center, Amsterdam; and
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Bonouvrié LA, Becher JG, Vles JSH, Boeschoten K, Soudant D, de Groot V, van Ouwerkerk WJR, Strijers RLM, Foncke E, Geytenbeek J, van de Ven PM, Teernstra O, Vermeulen RJ. Intrathecal baclofen treatment in dystonic cerebral palsy: a randomized clinical trial: the IDYS trial. BMC Pediatr 2013; 13:175. [PMID: 24165282 PMCID: PMC3840690 DOI: 10.1186/1471-2431-13-175] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/03/2013] [Indexed: 11/20/2022] Open
Abstract
Background Dystonic cerebral palsy is primarily caused by damage to the basal ganglia and central cortex. The daily care of these patients can be difficult due to dystonic movements. Intrathecal baclofen treatment is a potential treatment option for dystonia and has become common practice. Despite this widespread adoption, high quality evidence on the effects of intrathecal baclofen treatment on daily activities is lacking and prospective data are needed to judge the usefulness and indications for dystonic cerebral palsy. The primary aim of this study is to provide level one clinical evidence for the effects of intrathecal baclofen treatment on the level of activities and participation in dystonic cerebral palsy patients. Furthermore, we hope to identify clinical characteristics that will predict a beneficial effect of intrathecal baclofen in an individual patient. Methods/Design A double blind placebo-controlled multi-center randomized clinical trial will be performed in 30 children with dystonic cerebral palsy. Patients aged between 4 and 25 years old with a confirmed diagnosis of dystonic cerebral palsy, Gross Motor Functioning Classification System level IV or V, with lesions in the cerebral white matter, basal ganglia or central cortex and who are eligible for intrathecal baclofen treatment will be included. Group A will receive three months of continuous intrathecal baclofen treatment and group B will receive three months of placebo treatment, both via an implanted pump. After this three month period, all patients will receive intrathecal baclofen treatment, with a follow-up after nine months. The primary outcome measurement will be the effect on activities of and participation in daily life measured by Goal Attainment Scaling. Secondary outcome measurements on the level of body functions include dystonia, spasticity, pain, comfort and sleep-related breathing disorders. Side effects will be monitored and we will study whether patient characteristics influence outcome. Discussion The results of this study will provide data for evidence-based use of intrathecal baclofen in dystonic cerebral palsy. Trial registration Nederlands Trial Register,
NTR3642
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Affiliation(s)
- Laura A Bonouvrié
- Department of Rehabilitation Medicine, VU University Medical Center, Postbus 7057, 1007, MB Amsterdam, The Netherlands.
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Bolster EAM, van Schie PEM, Becher JG, van Ouwerkerk WJR, Strijers RLM, Vermeulen RJ. Long-term effect of selective dorsal rhizotomy on gross motor function in ambulant children with spastic bilateral cerebral palsy, compared with reference centiles. Dev Med Child Neurol 2013; 55:610-6. [PMID: 23557106 DOI: 10.1111/dmcn.12148] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2013] [Indexed: 12/16/2022]
Abstract
AIM The aim of this study was to evaluate the long-term effect of selective dorsal rhizotomy (SDR) on the gross motor function of ambulant children with spastic bilateral cerebral palsy (CP), compared with reference centiles. METHOD The study used a prospective cohort design and participants comprised 29 children classified using the Gross Motor Function Classification System (GMFCS) in level I (n=7), II (n=4), or III (n=18; 18 males, 11 females; median age at time of surgery 6 y 4 mo; range 2 y 10 mo-12 y 1 mo), who were examined 5 years and 10 years after SDR. We used individual centiles based on Gross Motor Function Measure (GMFM-66) scores and age, corresponding to the GMFCS levels. Individual improvement or deterioration was defined as a change of more than 20 centiles. Side effects experienced and additional treatment received after SDR were also recorded. RESULTS Five years after SDR, 10 out of 28 children showed improvement, and 10 years after SDR 6 out of 20 children had improved. Spinal side effects were noted in two children and hip subluxation in three. Additional treatments included subtalar arthrodesis (n=13), endorotational osteotomy of the tibia (n=5), and botulinum toxin treatment (n=13). INTERPRETATION None of the children showed deterioration of gross motor function based on centile ranking. Five and 10 years after SDR, gross motor function in some children had improved more than would have been expected according to the reference centiles. This suggests, taking the limitations of this study into account, that the applied criteria for selection were adequate. However, the children still required additional treatment after SDR.
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Affiliation(s)
- Eline A M Bolster
- Department of Rehabilitation Medicine, Physiotherapy Section, VU University Medical Center, Amsterdam, the Netherlands
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Oudeman EA, Martins Jarnalo CO, van Ouwerkerk WJR. [A man with severe traumatic brain injury]. Ned Tijdschr Geneeskd 2013; 157:A5535. [PMID: 23388139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We present a 41-year-old man with severe traumatic brain injury. Cranial imaging studies revealed cerebral contusion and a longitudinal fracture of the temporal bone. Several days later brain herniated into the left external auditory canal. Imaging studies showed the known skull fracture with a direct connection between the external acoustic meatus and the intracranial structures.
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Bonouvrié LA, van Schie PEM, Becher JG, van Ouwerkerk WJR, Vermeulen RJ. Intrathecal baclofen for progressive neurological disease in childhood: a systematic review of literature. Eur J Paediatr Neurol 2012; 16:279-84. [PMID: 22015172 DOI: 10.1016/j.ejpn.2011.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 02/10/2011] [Accepted: 07/18/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Intrathecal baclofen (ITB) treatment is frequently used for individuals with severe, but non-progressive, spasticity refractory to oral treatment. However, experiences with ITB in patients with progressive neurological disorders of childhood causing spasticity are limited. AIM To investigate whether ITB is an option in patients with progressive neurological disorders causing spasticity in childhood. DESIGN A systematic literature search in Embase, Pubmed and the Cochrane Library was performed. RESULTS We identified six eligible studies considering patients with progressive neurological disease in childhood and receiving ITB treatment. The studies included a total of seven paediatric patients and four adult patients. Improvement was reported in spasticity, spasms, pain, gait, activities of daily life and providing care. High satisfaction is described. CONCLUSIONS ITB has beneficial effects in paediatric patients with progressive neurological disease. However, the level of evidence is limited due to the small number of available studies and due to the poor quality of these studies.
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Affiliation(s)
- Laura A Bonouvrié
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Bonouvrié LA, van Schie PEM, Becher JG, van Ouwerkerk WJR, Reeuwijk A, Jeroen Vermeulen R. Effects of intrathecal baclofen on daily care in children with secondary generalized dystonia: a pilot study. Eur J Paediatr Neurol 2011; 15:539-43. [PMID: 21628102 DOI: 10.1016/j.ejpn.2011.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 04/20/2011] [Accepted: 05/06/2011] [Indexed: 11/26/2022]
Abstract
AIM Treatment options for dystonic cerebral palsy (CP) are limited. Our aims were to determine whether intrathecal baclofen (ITB) improves daily care, decreases dystonia and decreases pain in patients with dystonic CP. METHODS Patients received randomized blinded treatment with ITB or placebo. Scores on problems of daily care were recorded and dystonia, pain and comfort were assessed. RESULTS Four patients (three males, average age 12 years 6 months) were included (all Gross Motor Function Classification System level V). During the trial period problem scores and dystonia scores decreased in all four patients. CONCLUSION In this pilot study we report positive functional effects of ITB trial treatment in four patients with dystonic CP. A randomized trial with a larger cohort is needed to verify these results.
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Affiliation(s)
- Laura A Bonouvrié
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Spaargaren E, Ahmed J, van Ouwerkerk WJR, de Groot V, Beckerman H. Aspects of activities and participation of 7-8 year-old children with an obstetric brachial plexus injury. Eur J Paediatr Neurol 2011; 15:345-52. [PMID: 21511503 DOI: 10.1016/j.ejpn.2011.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 03/04/2011] [Accepted: 03/21/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children with an obstetric brachial plexus injury (OBPI) can experience problems in the performance of meaningful activities such as writing, bimanual activities, and participation in sports and leisure activities. AIMS To quantify the everyday functioning and participation of 7-8 year-old children with an OBPI, with special emphasis on writing, and to investigate associated characteristics. METHODS Parents of children with an OBPI were sent a self-report questionnaire regarding the school performance, writing abilities, bimanual hand use, and participation in sports and leisure activities of their child, assessed with the Vineland Adaptive Behavior Scales (VABS sub-scale writing), the ABILHAND-kids, and the Children's Assessment of Participation and Enjoyment (CAPE). Furthermore, questions were asked about socio-demographic variables, medical history, pain, and the use of assistive devices. RESULTS Fifty three questionnaires were filled in (response 61%). According to the parents, 66% of their children were almost completely recovered, and 58% had a near normal arm function. Most of the children preferred to use their non-involved hand. More than 45% of the children complained about pain, and 39.6% had difficulties with writing, which resulted in a mean developmental delay of 8 months on the VABS sub-scale. Children with writing problems significantly more often had neurosurgery, were living with a single parent, more often received assistance at school, and had a significantly lower ABILHAND-kids score, compared to children with no writing problems. CONCLUSIONS Large percentages of 7-8 year-old children with an OBPI experience difficulties with writing and have musculoskeletal pain. Restrictions in participation were less pronounced.
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Affiliation(s)
- Els Spaargaren
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
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12
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van Schie PEM, Schothorst M, Dallmeijer AJ, Vermeulen RJ, van Ouwerkerk WJR, Strijers RLM, Becher JG. Short- and long-term effects of selective dorsal rhizotomy on gross motor function in ambulatory children with spastic diplegia. J Neurosurg Pediatr 2011; 7:557-62. [PMID: 21529199 DOI: 10.3171/2011.2.peds10452] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECT The primary aim of this prospective cohort study was to evaluate the short-term (1 year) and long-term (mean 6 years) effects of selective dorsal rhizotomy (SDR) on gross motor function and spasticity in ambulatory children with spastic diplegia. Secondary aims were to investigate side effects, additional treatment during follow-up (botulinum toxin type A injections or orthopedic surgery), and parental satisfaction. METHODS Thirty-three children who had undergone SDR at a mean age of 6 years and 7 months (± 2 years) were included. There were 7 children at Gross Motor Function Classification System (GMFCS) Level I, 7 at Level II, and 19 at Level III. Gross motor function was assessed with the Gross Motor Function Measure-66 (GMFM-66). Spasticity was measured according to a modified Tardieu scale. Side effects, additional treatment, and parental satisfaction were recorded using a parental questionnaire and medical records. RESULTS At 1-year follow-up, mean GMFM-66 scores improved significantly by 4.3 ± 4.1 points. Children at GMFCS Levels I and II showed significantly more improvement (7.2 points) on the GMFM-66 compared with children at GMFCS Level III (2.9 points). On long-term follow-up (mean 6 years ± 22 months), mean GMFM-66 scores improved significantly by 6.5 ± 5.9 points, without a difference between children at GMFCS Levels I and II and Level III. No relapse of spasticity was noted. Ten children (30%) needed orthopedic surgery and 13 children (39%) received botulinum toxin type A treatment after SDR. Twenty (91%) of the 22 parents who answered the questionnaire at long-term follow-up believed that their child's functioning had improved after SDR. CONCLUSIONS Selective dorsal rhizotomy resulted in short- and long-term improvements in gross motor function, without relapse of spasticity. However, the majority of the children still needed additional surgery or botulinum toxin A treatment.
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Affiliation(s)
- Petra E M van Schie
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
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13
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Spijker M, Strijers RLM, van Ouwerkerk WJR, Becher JG. Disappearance of spasticity after selective dorsal rhizotomy does not prevent muscle shortening in children with cerebral palsy: a case report. J Child Neurol 2009; 24:625-7. [PMID: 19151363 DOI: 10.1177/0883073808325652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Selective dorsal rhizotomy is an effective treatment for spasticity in children with cerebral palsy who have a spastic motor disorder. It is hypothesized that muscle shortening is related to spasticity; the lack of stretch of a muscle is thought to be the cause of muscle shortening. If this is true, the treatment for spasticity should prevent the occurrence of muscle shortening during growth. We present the case of 1 child with cerebral palsy and spastic diplegia, for whom the treatment with selective dorsal rhizotomy was successful in improving the walking abilities. She did, however, develop muscle shortening during growth. In conclusion, the development of muscle shortening during growth in children with cerebral palsy and spastic paresis cannot be prevented by treatment for the spasticity alone.
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Affiliation(s)
- Margje Spijker
- Rehabilitation Centre Heliomare, Wijk aan Zee, The Netherlands.
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Grunt S, van der Knaap MS, van Ouwerkerk WJR, Strijers RLM, Becher JG, Vermeulen RJ. Effectiveness of selective dorsal rhizotomy in 2 patients with progressive spasticity due to neurodegenerative disease. J Child Neurol 2008; 23:818-22. [PMID: 18658081 DOI: 10.1177/0883073808316372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Selective dorsal rhizotomy at the lumbar level is a neurosurgical procedure, which reduces spasticity in the legs. Its effect has mainly been studied in children with spastic cerebral palsy. Little is known about the outcome of selective dorsal rhizotomy in patients with neurodegenerative disorders. We report the clinical course after selective dorsal rhizotomy in 2 patients with progressive spasticity. Leg spasticity was effectively and persistently reduced in both patients, facilitating care and improving sitting comfort. However, spasticity of the arms and other motor disturbances, such as spontaneous extension spasms and the ataxia, increased gradually in time. Selective dorsal rhizotomy leads to a disappearance of leg spasticity in patients with a neurodegenerative disease. Other motor signs are not influenced and may increase due to the progressive nature of the underlying disease.
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Affiliation(s)
- Sebastian Grunt
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
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15
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van Ouwerkerk WJR, Uitdehaag BMJ, Strijers RLM, Frans N, Holl K, Fellner FA, Vandertop WP. Accessory Nerve to Suprascapular Nerve Transfer to Restore Shoulder Exorotation in Otherwise Spontaneously Recovered Obstetric Brachial Plexus Lesions. Neurosurgery 2006; 59:858-67; discussion 867-9. [PMID: 17038950 DOI: 10.1227/01.neu.0000232988.46219.e4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AbstractOBJECTIVE:A systematic follow-up of infants with an obstetric brachial plexus lesion of C5 and C6 or the superior trunk showing satisfactory spontaneous recovery of shoulder and arm function except for voluntary shoulder exorotation, who underwent an accessory to suprascapular nerve transfer to improve active shoulder exorotation, to evaluate for functional recovery, and to understand why other superior trunk functions spontaneously recover in contrast with exorotation.METHODS:In 54 children, an accessory to suprascapular nerve transfer was performed as a separate procedure at a mean age of 21.7 months. Follow-up examinations were conducted before and at 4, 8, 12, 24, and 36 months after operation and included scoring of shoulder exorotation and abduction. Intraoperative reactivity of spinatus muscles and additional needle electromyographic responses were registered after electrostimulation of suprascapular nerves. Histological examination of suprascapular nerves was performed. Trophy of spinatus muscles was followed by magnetic resonance imaging scanning. The influence of perinatal variables and results of ancillary investigations on outcome were evaluated.RESULTS:Exorotation improved from 70 degrees to functional levels exceeding 0 degrees, except in two patients. Abduction improved in 27 patients, with results of 90 degrees or more in 49 patients. Electromyography at 4 months did not show signs of denervation in 39 out of 40 patients. Intraoperative electrostimulation of suprascapular nerves elicited spinatus muscle reaction in 44 out of 48 patients. Histology of suprascapular nerves was normal. Preoperative magnetic resonance imaging scans showed only minor wasting of spinatus muscles in contrast with major wasting after successful operations.CONCLUSION:An accessory to suprascapular nerve transfer is effective to restore active exorotation when performed as the primary or a separate secondary procedure in children older than 10 months of age. Contradictory spontaneous recovery of other superior trunk functions and integrity of suprascapular nerves, as well as absence of spinatus muscle wasting direct to central nervous changes are possible main causes for the lack of exorotation.
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Affiliation(s)
- Willem J R van Ouwerkerk
- Department of Neurosurgery, Vrije Universiteit University Medical Centre Amsterdam, Amsterdam, The Netherlands.
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16
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van Ouwerkerk WJR, Strijers RLM, Barkhof F, Umans U, Vandertop WP. Detection of Root Avulsion in the Dominant C7 Obstetric Brachial Plexus Lesion: Experience with Three-dimensional Constructive Interference in Steady-state Magnetic Resonance Imaging and Electrophysiology. Neurosurgery 2005; 57:930-40; discussion 930-40. [PMID: 16284563 DOI: 10.1227/01.neu.0000180813.10843.d4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE:
Preoperative, reliable detection by ancillary investigations of spinal nerve root avulsions in infants with severe obstetric brachial plexus lesions to avoid ineffective operative repair from deceivingly intact but actually avulsed nerve roots.
METHODS:
Ten infants were selected with an infrequent, severe dominant C7 lesion, primarily because of the anatomically distinct supraclavicular course of this spinal nerve. Three-dimensional constructive interference in steady-state magnetic resonance imaging (3D CISS MRI) studies under mild sedation were performed and evaluated for detection of avulsed nerve roots by two experienced neuroradiologists. Preoperative electrodiagnostics (electromyography and somatosensory evoked potentials) as well as intraoperative somatosensory potentials and muscle contractions after electrostimulation were recorded. Preoperative and intraoperative ancillary investigations were correlated with intraoperative findings in eight patients and clinical status in two children who recovered spontaneously.
RESULTS:
Despite two minor motion artifacts, the quality of the 3D CISS MRI studies was good. In 8 of 10 patients, prediction of root continuity was consistent with operative or clinical findings, and 2 remained doubtful. Preoperative and intraoperative electrodiagnostics tended not to correlate with intraoperative findings in this small, selected group.
CONCLUSION:
3D CISS MRI provides good images of anterior and posterior spinal roots in infants with obstetric brachial plexus lesions. Images seem to allow accurate prediction of root avulsion in the majority of patients. In this study, electrodiagnostics were of limited value.
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Affiliation(s)
- Willem J R van Ouwerkerk
- Department of Neurosurgery, Vrije Universiteit, University Medical Center, Amsterdam, The Netherlands.
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van Schie PEM, Vermeulen RJ, van Ouwerkerk WJR, Kwakkel G, Becher JG. Selective dorsal rhizotomy in cerebral palsy to improve functional abilities: evaluation of criteria for selection. Childs Nerv Syst 2005; 21:451-7. [PMID: 15703968 DOI: 10.1007/s00381-004-1105-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2004] [Revised: 10/15/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate the effect of selective dorsal rhizotomy (SDR) on functional abilities in a well-defined group of ambulatory children with spastic diplegia. METHODS Nine children were selected for SDR (mean age 65 months, range 43-82 months). Gross motor function was measured with the Gross Motor Function Measure (GMFM-88). Self-care was assessed with the Pediatric Evaluation of Disability Inventory (PEDI) and gait pattern was measured with the Edinburgh Visual Gait Score (EGS). There were nine single-case research designs with a 12-month follow-up after surgery. RESULTS After 12 months the mean improvement in the total GMFM-88 scores was 8.8%. On an individual level, all patients improved significantly in comparison with baseline. Functional skills and care-giver assistance measured with the PEDI showed significant improvement. Improvement in gait was also found; in particular, better initial contact and heel-lift resulted in an increased EGS. CONCLUSION In this well-defined group of ambulatory children SDR had a small but significant positive effect on gross motor function, self-care and gait pattern.
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Affiliation(s)
- Petra E M van Schie
- Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
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van der Sluijs JA, van Ouwerkerk WJR, de Gast A, Nollet F, Winters H, Wuisman PIJM. Treatment of internal rotation contracture of the shoulder in obstetric brachial plexus lesions by subscapular tendon lengthening and open reduction: early results and complications. J Pediatr Orthop B 2004; 13:218-24. [PMID: 15083126 DOI: 10.1097/00009957-200405000-00015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
In this prospective study of 19 consecutive children, the operative treatment of internal rotation contracture of the shoulder in obstetric brachial plexus lesions by subscapular tendon lengthening and open reduction of the humeral head is evaluated. The average age of the children was 3.7 years and average follow-up was 20 months. Active shoulder function, as measured by the Mallet score, improved significantly in the dimensions of external rotation, hand-mouth movement and hand-neck movement. However, eight of the 19 children developed a severe, functionally disturbing external rotation contracture of the shoulder. This contracture was found predominantly in children who had a lower preoperative Mallet score for abduction and hand-back movement.
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Affiliation(s)
- Johannes A van der Sluijs
- Department of Orthopaedic Surgery, Vrije University Medical Centre, Postbus 70-57, 1007 MB Amsterdam, The Netherlands.
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Hoeksma AF, ter Steeg AM, Nelissen RGHH, van Ouwerkerk WJR, Lankhorst GJ, de Jong BA. Neurological recovery in obstetric brachial plexus injuries: an historical cohort study. Dev Med Child Neurol 2004; 46:76-83. [PMID: 14974631 DOI: 10.1017/s0012162204000179] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An historical cohort study was conducted to investigate the rate and extent of neurological recovery in obstetric brachial plexus injury (OBPI) and to identify possible prognostic factors in a cohort of children with OBPI from birth to 7 years. All children (n=56; 31 females, 25 males) with OBPI were evaluated at fixed time intervals by one examiner. They underwent a final neurological examination at a mean age of 3 years 10 months (range 1 to 7 years). Neurological outcome was not as favourable as is often reported: complete neurological recovery occurred in 37 out of 56 children (66%). In half of these there was delayed recovery, in which case complete neurological recovery was assessed from 1.5 to 16 months of age (median age 6.5 months, SD 4.2 months). External rotation and supination were the last to recover and recovered the least. Although biceps function at three months was considered to be the best indicator for operative treatment, external rotation and supination were found to be better in predicting eventual complete recovery. Initial symptoms directly post partum were not found to be prognostic. Functional outcome was mainly reported to be good.
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Affiliation(s)
- Agnes F Hoeksma
- Department of Rehabilitation Medicine, Academic Medical Centre, Amsterdam.
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