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C. Keith Whittaker

C erebellar stimulation has held out the hope of releasing latent capacities of spastic and athetotic children. 1, 2, 5 Because spasticity varies so much with effort, anxiety, rest, or distraction, the effect of cerebellar stimulation on cerebral palsy is difficult to measure. 3, 6 The method of videotaping before and after cerebellar stimulation proved inconclusive. Patients and family members sometimes reported that there was marked improvement in function when the stimulating apparatus was not even working. This double-blind study was therefore devised to

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V. Balasubramaniam, T. S. Kanaka and P. B. Ramanujam

T he management of cerebral palsy by neurosurgical methods is not new. In 1890 Sir Victor Horsley 10 treated a case of athetosis by excision of the motor strip. Many dyskinesias which form part of the symptom complex have been treated by open craniotomy and division of various tracts. 24 However, cerebral palsy has mostly been managed along orthopedic lines. The term cerebral palsy is now applied to any condition where there is a non-progressive disorder predominantly of movement and posture, resulting from damage to the brain sustained in the first few

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Chronic cerebellar stimulation for cerebral palsy

Prospective and double-blind studies

Richard D. Penn, Barbara M. Myklebust, Gerald L. Gottlieb, Gyan C. Agarwal and Mary E. Etzel

C hronic electrical stimulation of the cerebellum has been employed to reduce spasticity and improve motor function in patients with cerebral palsy. 1 Since Cooper 1 introduced the procedure 7 years ago, over a thousand patients have had the operation. As with many new surgical procedures, there has been considerable controversy over its effectiveness. Some surgeons have reported improvement in 95% to 98% of their patients, whereas others have given up the procedure because they found no beneficial effects. 2, 5 The only double-blind trial that has been

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Robert F. Heimburger, Anita Slominski and Patricia Griswold

S pasticity , one of the most common and disabling neurological disorders, is alleviated very little by available treatment. Drugs, occupational and physical therapy, and muscle lengthening or transfer have only a limited benefit. Operations on the nervous system have not been widely used because it is difficult to relax muscles without paralyzing them. A variety of stereotaxic surgical techniques for alleviating spasticity have been tried. In 1970, Kottke 3 reported decreased spasticity in six patients with cerebral palsy following bilateral cervical

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David L. Ratusnik, Virginia I. Wolfe, Richard D. Penn and Sheila Schewitz

T raditionally , disordered speech and voice characteristics of patients with cerebral palsy have been treated by speech and language pathologists. Unfortunately, intervention techniques designed to facilitate oral 2, 11, 13–15, 24, 25, 27 or nonverbal means 1, 5, 6, 10, 12, 16, 17, 20, 22 of communication have met with little success. This is particularly true for oral communication in the patient with severe neuromuscular involvement. Recent reports suggesting that speech is improved by chronic cerebellar stimulation of the anterior lobe deserve close

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A. Leland Albright, Margaret J. Barry, Michael J. Painter and Barbara Shultz

indicate that continuous infusion of intrathecal baclofen reduces generalized dystonia in some patients with CP. Thus far we cannot identify factors that might predict the response of dystonia to intrathecal baclofen. Additional investigations are being conducted to evaluate long-term responses and functional and quality-of-life outcomes. References 1. Albright AL : Intrathecal baclofen in cerebral palsy movement disorders. J Child Neurol 11 (Suppl 1) : S29 – S35 , 1996 Albright AL: Intrathecal baclofen in cerebral palsy

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Sean M. Jones-Quaidoo, Scott Yang and Vincent Arlet

child with developmental delay to an ambulatory child with normal intelligence. Most patients with CP present with muscle spasticity; therefore, this paper will focus on the treatment of patients with the spastic type of scoliosis prevalent in patients with CP. Epidemiology of CP Cerebral palsy is a nonprogressive encephalopathy caused by a brain dysfunction that occurs during the pre-, peri-, or postnatal phase of development. Cerebral palsy can be characterized by a lack of muscle control with increased spasticity or decreased tone, seizure disorder, and

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Robert C. Heim, T. S. Park, George P. Vogler, Bruce A. Kaufman, Michael J. Noetzel and Madeleine R. Ortman

H ip subluxation and dislocation are common problems in children with spastic cerebral palsy, occurring in 3% to 59% of patients. 16, 21, 23, 40, 43 The cause of these hip abnormalities is multifactorial, but predominant spasticity in the hip flexors and adductors probably plays an important role in the development of abnormalities. 3, 14, 37 To manage hip deformities in cerebral palsy, a variety of orthopedic operations are currently used, which primarily aim to restore a balanced muscle strength around the hip or replace the femoral head in the hip joint

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Christopher L. Vaughan, Barbara Berman and Warwick J. Peacock

S pasticity is a major problem in children with cerebral palsy. Cerebral palsy is a motor disorder due to a nonprogressive perinatal insult to the developing brain. Approximately 25,000 children are born with or develop cerebral palsy in the United States each year. 3 One of the neurosurgical options available for reduction of spasticity in cerebral palsy is selective posterior rhizotomy. Posterior rhizotomy for relief of spasticity was first reported in 1908 by the Germany neurosurgeon Foerster, 8 although he credited Monro with similar work as early as

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Warwick J. Peacock and Loretta A. Staudt

T he selective posterior rhizotomy procedure for spastic cerebral palsy has been increasingly used by pediatric neurosurgeons at major medical centers throughout the United States. Although the value of this treatment has been demonstrated in carefully selected cases, 1, 10 objective documentation of surgical outcome is difficult to achieve and has only recently been addressed. 6, 11 As cerebral palsy is a complex motor disorder which varies in type and severity, and the population under study is maturing with time, several research design issues can be