TY - JOUR
T1 - Long-term effects of spasticity treatment, including selective dorsal rhizotomy, for individuals with cerebral palsy
AU - Selective Dorsal Rhizotomy Outcomes Research Team
AU - MacWilliams, Bruce A.
AU - McMulkin, Mark L.
AU - Duffy, Elizabeth A.
AU - Munger, Meghan E.
AU - Chen, Po-Jung "Brian"
AU - Novacheck, Tom F.
AU - Schwartz, Michael H.
AU - Carroll, Kristen L.
AU - Stotts, Alan K.
AU - Carter, Lisa H.
AU - Mader, Shelley L.
AU - Hayes, Brianna
AU - Baird, Glen O.
N1 - Publisher Copyright:
© 2021 Mac Keith Press.
PY - 2022/5
Y1 - 2022/5
N2 - AIM: To understand the long-term effects of comprehensive spasticity treatment, including selective dorsal rhizotomy (SDR), on individuals with spastic cerebral palsy.METHOD: This was a pre-registered, multicenter, retrospectively matched cohort study. Children were matched on age range and spasticity at baseline. Children at one center underwent spasticity treatment including SDR (Yes-SDR, n=35) and antispastic injections. Children at two other centers had no SDR (No-SDR, n=40 total) and limited antispastic injections. All underwent subsequent orthopedic treatment. Participants returned for comprehensive long-term assessment (age ≥21y, follow-up ≥10y). Assessment included spasticity, contracture, bony alignment, strength, gait, walking energy, function, pain, stiffness, participation, and quality of life.RESULTS: Spasticity was effectively reduced at long-term assessment in the Yes-SDR group and was unchanged in the No-SDR group. There were no meaningful differences between the groups in any measure except the Gait Deviation Index (Yes-SDR + 11 vs No-SDR + 5) and walking speed (Yes-SDR unchanged, No-SDR declined 25%). The Yes-SDR group underwent more subsequent orthopedic surgery (11.9 vs 9.7 per individual) and antispastic injections to the lower limbs (14.4 vs <3, by design).INTERPRETATION: Untreated spasticity does not cause meaningful impairments in young adulthood at the level of pathophysiology, function, or quality of life.
AB - AIM: To understand the long-term effects of comprehensive spasticity treatment, including selective dorsal rhizotomy (SDR), on individuals with spastic cerebral palsy.METHOD: This was a pre-registered, multicenter, retrospectively matched cohort study. Children were matched on age range and spasticity at baseline. Children at one center underwent spasticity treatment including SDR (Yes-SDR, n=35) and antispastic injections. Children at two other centers had no SDR (No-SDR, n=40 total) and limited antispastic injections. All underwent subsequent orthopedic treatment. Participants returned for comprehensive long-term assessment (age ≥21y, follow-up ≥10y). Assessment included spasticity, contracture, bony alignment, strength, gait, walking energy, function, pain, stiffness, participation, and quality of life.RESULTS: Spasticity was effectively reduced at long-term assessment in the Yes-SDR group and was unchanged in the No-SDR group. There were no meaningful differences between the groups in any measure except the Gait Deviation Index (Yes-SDR + 11 vs No-SDR + 5) and walking speed (Yes-SDR unchanged, No-SDR declined 25%). The Yes-SDR group underwent more subsequent orthopedic surgery (11.9 vs 9.7 per individual) and antispastic injections to the lower limbs (14.4 vs <3, by design).INTERPRETATION: Untreated spasticity does not cause meaningful impairments in young adulthood at the level of pathophysiology, function, or quality of life.
KW - Adult
KW - Cerebral Palsy/complications
KW - Child
KW - Cohort Studies
KW - Humans
KW - Muscle Spasticity/drug therapy
KW - Quality of Life
KW - Retrospective Studies
KW - Rhizotomy/adverse effects
KW - Treatment Outcome
KW - Young Adult
UR - http://www.scopus.com/inward/record.url?scp=85118874972&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85118874972&partnerID=8YFLogxK
U2 - 10.1111/dmcn.15075
DO - 10.1111/dmcn.15075
M3 - Article
C2 - 34755903
AN - SCOPUS:85118874972
SN - 0012-1622
VL - 64
SP - 561
EP - 568
JO - Developmental Medicine and Child Neurology
JF - Developmental Medicine and Child Neurology
IS - 5
ER -