[Preliminary results of chronic intrathecal therapy in treatment of spastic syndromes of various etiologies].

OBJECTIVE: To estimate the effectiveness of the chronic intrathecal baclofen infusion (ITB) for the treatment of botuloresistant spastic disorders. MATERIAL AND METHODS: ITB have been performed in 15 cases of spastic disorders. In 8 cases spasticity was the result of cerebral palsy, 5 - spinal cord injure, 1 - cerebral injure, 1 - pyogenic spinal epiduritis. The results of surgical treatment were estimated with the Ashworth, GMFM-88 and Arens scales. These data have been exposed statistically analysis. RESULTS: Significantly decrease of spasticity have been revealed in most cases: from 4.26±0.7 points before the operation to 1.8±0.67 points after the operation (p<0.004). In 8 cases we have observed improvement in motor functions. CONCLUSION: ITB is an effective procedure which leads to decreasing of spasticity, incree of movement volume and improvement in motor functions in patients with spastic disorders.

[Long-term outcomes of SDR in various groups of cerebral palsy (CP) patients].

AIM: Long-term outcomes of selective dorsal rhizotomy (SDR) are not sufficiently summarized in the literature. The aim of this study was to systematize and evaluate long-term outcomes of SDR in various groups of cerebral palsy (CP) patients. MATERIAL AND METHODS: 47 patients with spastic CP were operated. In all cases, SDR of the L1-S1 roots was performed under EMG control. In all cases, laminoplasty was used as an approach. Outcomes of surgical treatment were estimated by the Ashworth scale and the GMFM 88 scale. The data were subjected to statistical analysis. The follow-up duration ranged from 12 months to 7 years. RESULTS: A significant reduction in spasticity from 4.34±0.53 points before surgery to 1.61±0.45 points after surgery (p<0.001) was observed in most cases. The dynamics of locomotor functions was maximal in the 3rd GMFM class: changing from 48±4% points before operation to 52±6% points 12 months after operation (p<0.042). The dynamics of locomotor functions amounted to 2% in the 4th GMFM class and 1% in the 5th GMFM class. The best functional outcomes were obtained in children under 10 years of age. A positive correlation only between the percentage of cut roots and a decrease in spasticity (r= 0.85) was found. No correlation between the amount of cut roots and the dynamics of locomotor functions was observed. No spinal cord deformities were observed during the follow-up period. CONCLUSION: A reduction in spasticity due to SDR depends on the amount of cut roots. The functional result of SDR is affected not only by a decrease in spasticity but also by the functional status and age of the patient at the time of surgery. In all cases, laminoplasty should be performed to prevent spinal cord deformities.