Selective Posterior Rhizotomy(SPR) for Treatment of Spasticity in the Patient with Cerebral Palsy

A selective posterior rhizotomy(SPR) was done for reducing spasticity in 18 patients with cerebral palsy. Based on a standard techniques developed by Fasano(Lumbar SPR) and Heimberger(Cervical SPR), we dissected L1-S1 dorsal rootlets through T12, L1 laminectomy in 10 patients and C5-C8 dorsal rootlets through C5-C7 laminectomy in 8 patients. All the rootlets from each root were electrically stimulated with bipolar electrodes(1 sec, 1-50 mV). The muscle responses were observed visually and recorded by intraoperative 8-channel electromyography. The rootlets showing abnormal motor responses visually and electromyopraphically were divided and cut. The Patients were accessed preoperatively and postoperatively in terms of clinical, functional, electrophysiological evaluations. Reduction of spasticity was observed in 9 patients in Lumbar SPR, and 5 patients cervical SPR. Recurrence was seen in 3 patients in Lumbar SPR, and 3 patients in cervical SPR. It was noticed that the reasons for the bad outcomes was due to improper division and selection of the rootlets which should be cut. These results was shown that SPR could be effective for treating spasticity in the patients of cerebral palsy and more selective section of the rootlets based on neurophysiologic monitoring during operation might maximize its effectiveness on SPR in the treatment of spasticity.

Electroencephalographic, Behavioral and Pathologic Characteristics in Experimental Complex Partial Seizure Induced by Microinjection of Kainic Acid into the Unilateral Amygdala in the Rat

Kainic acid(KA) is an excitotoxic analogue of glutamate which is now widely used in the studies of epilepsy. Electroencephalographic, behavioral and pathologic observation were done for 2 months after microinjection of kainic acid(Kainic acid group;0.4 microgram, 0.8 microgram, 1.2 microgram, 1.6 microgram, 2.0 microgram, 3.0 microgram) and phosphate buffer solution(Control group) into the left basolateral amygdala(AMG) in 30 Spaque-Doley rats. The control group showed no change in EEG and behavior during the observation period and pathologic findings were normal. One of four rats which 1.2 microgram of KA was injected, four of six rats of 1.6 microgram, all six rats of 2.0 microgram, one of four rats of 3.0 microgram developed acute complex partial seizure and multiple epileptic spikes with high amplitude in EEG. One of four rats of 1.2 microgram, one of six rats of 1.6 microgram, three of six rats of 2.0 microgram, showed spontaneous limbic seizure 14~21days after kainic acid injection. Among those which developed spontaneous limbic seizure, two rats demonstrated spontaneous secondarily generalized seizure 30~60days after kainic acid injection. Pathological examination revealed focal necrosis with perifocal gliosis at the tip of the cannula in the left amygdala. Neuronal cell loss was observed in the CA3 portion of pyramidal cell layer of the hippocampus on the injected side of KA, which developed spontaneous secondarily generalized seizure. But the cellular architecture was normal in the contralateral hippocampus. This is regarded as a good medel of spontaneous generalized complex partial seizure, which is similar to that of temporal lobe epilepsy in human.