ABSTRACT
The increasing interest in selective posterior rhizotomy for reduction of spasticity in children with cerebral palsy and other neurological disorders comes from the selectivity that this procedure has achieved with intraoperative electromyographic monitoring. Thirty patients were operated on between April 1989 and October 1991. Spasticity was of cerebral origin in 27 cases and secondary to spinal cord lesion in 3 others. A reduction in the abnormally high muscle tone was observed in all cases, mainly in the lower extremities, but also, to a lesser degree, in the upper extremities. All patients showed functional improvements that depended on the individual preoperative condition. Even severely disabled patients with quadriplegia and intellectual impairment, whose spasticity interfered with their daily care, had a significantly improved quality of life after rhizotomy. These patients became much looser, with better swallowing and less drooling, and were much more easily managed by their caretakers. Preliminary results with follow-up from 1 to 30 months indicates that selective posterior rhizotomy is a safe procedure which contributes to significant functional improvement in spastic patients.
Subject(s)
Cerebral Palsy/surgery , Muscle Spasticity/surgery , Spinal Nerve Roots/surgery , Adolescent , Adult , Brain Damage, Chronic/etiology , Brain Damage, Chronic/physiopathology , Brain Damage, Chronic/surgery , Cerebral Palsy/etiology , Cerebral Palsy/physiopathology , Child , Child, Preschool , Electromyography/instrumentation , Female , Follow-Up Studies , Humans , Male , Monitoring, Intraoperative/instrumentation , Muscle Spasticity/etiology , Muscle Spasticity/physiopathology , Muscles/innervation , Neurologic Examination , Spinal Cord Diseases/etiology , Spinal Cord Diseases/physiopathology , Spinal Cord Diseases/surgery , Spinal Nerve Roots/physiopathologyABSTRACT
Seventy five patients with the diagnosis of chronic Chagas' disease were studied by employing EPs techniques. Two of them had delayed arrival of the signal to the Erb's point and one to the spinal cord when looking at SEPs. Two patients had increment of the time interval between waves Ist and IIIrd, when studying PEATs. These findings were interpreted as due to peripheral nerve fibers damage, a feature described in previous papers. The most striking finding was the prolonged time interval between waves N13 and N20 (SEPs) found in two patients and between waves IIIrd and Vth (PEAT) seen in 7 affected subjects. These observations suggested the development of some sort of CNS involvement, perhaps related to myelin damage, in patients who reached the chronic state of the infection.
Subject(s)
Brain Stem/physiopathology , Chagas Disease/physiopathology , Evoked Potentials , Adolescent , Adult , Evoked Potentials, Auditory , Evoked Potentials, Somatosensory , Female , Humans , Male , Middle AgedABSTRACT
An electrophysiological investigation of the state of the neuromuscular transmission (nmt) was carried out in 58 patients with the diagnosis of chronic Chagas' disease. On repetitive supramaximal nerve stimulation it was found that some patients did not show abnormalities, others had decremental muscle responses, others developed enhancement of the muscle evoked potential amplitudes, while some other patients combined both types of pathological responses. The findings suggest that some patients with chronic Chagas' disease develop impairment of nmt, though data obtained in this study do not give information about neither the type of impairment nor the localization (pre or postsynaptic, or both) of the damage.
