Neurosurgical approach for spasticity

Abstract

Spasticity is one of the neurological symptoms that neurosurgeons are often involved in treating. As for the neurosurgical procedures used to treat patients with spasticity, continuous intrathecal baclofen (ITB) therapy, botulinum toxin (BTX) injections and a selective peripheral neurotomy are indicated for the management of severe spasticity, and selective dorsal rhizotomy (SDR) is applied for spasticity due to cerebral palsy. Since BTX interferes with neural transmission by blocking the release of acetylcholine, the maximum cumulative dose should not be exceeded. Therefore, BTX treatment is best suited to reduce localized spasticity of the upper extremity or of the lower leg. Baclofen is an agonist GABA-B receptor which diffuses in the dorsal grey column of the spinal cord. Compared with BTX therapy, ITB infusion can treat a large area of spasticity in the body. The effect of both ITB infusion and BTX therapy are revers­ible and doctors can determine the proper dosages required to best manage spasticity. Selective peripheral neurotomy and SDR, by contrast, are irreversible treatments, but they are effective for spasticity as well. In this report, we present several clinical experiences with ITB infusion and BTX therapy for patients with spasticity.