Cerebral Palsy

Specialty Area: Pediatric Neurosurgery

Cerebral Palsy (CP) is caused by birth injuries that affect the central nervous system, also called static encephalopathy. Less than one percent of children are born with this type of injury. Almost half the children affected by CP develop hypertonia (excessive muscle tension) or spasticity (excessive muscle tension with increased tendon reflexes). This is usually caused by damage to the white matter of the brain. Other affected children can have mixed cerebral palsy, experiencing multiple symptoms with a spastic component. CP can result in irreversible damage and dysfunction of the nervous system.

There are several types of injuries that can impair the nervous system, including:

• Head injuries
• Central nervous system infections
• Episodes that obstruct the oxygen flow to the brain, such as near-drowning experiences
• Cerebrovascular accidents, like stroke
• Malnutrition
• Heavy metal ingestion

There are three ways that spasticity, or excessive tightening of muscles, can present itself in children suffering from cerebral palsy:

• Spastic diplegia, where the lower limbs are more involved than the upper. This typically affects premature children, born before 32 weeks gestation.
• Spastic quadriplegia, where all four limbs are involved equally. This typically affects children born closer to term.
• Spastic hemiplegia, where only one side of the body is involved. This typically affects children who have a history of ventricular bleeding that reaches their brain tissue, causing injury.

Hopkins Treatment
Baclofen (Liorisol) – Baclofen is a muscle relaxant. It can be absorbed into the bloodstream when taken orally, or it can be inserted directly into the cerebrospinal fluid (CSF). This method was recently approved by the FDA, and is particularly effective because it delivers the drug directly to the target site in the spinal cord.

To deliver baclofen to the CSF, an access device must be implanted underneath the skin and fat of the abdominal wall, requiring a two inch incision above the waistline. After the device is implanted, a needle is used to place a small, flexible tube into the lower back’s spinal fluid column near the targeted muscles. A child is usually required to stay in the hospital for a few days to recover from the procedure and allow physicians to monitor their progress. The device itself is a small titanium disk, about one inch thick and three inches wide. It contains a refillable reservoir for the drug and a computer chip that regulates the dose. An alarm sounds when the device needs to be refilled, the battery is low or the pump is not delivering the drug. The pump should be refilled and medication adjusted every two to three months.

Therapeutic electrical stimulation (TES) – TES is a type of electrical stimulation used at night while patients are sleeping. It increased blood flow to weakened muscles to allow the body to deliver more growth factors and nutrients to repair damaged tissue. This process usually takes between three and six months. Children usually undergo physical therapy in conjunction with the treatment to increase muscle strength.

Selective Dorsal Rhizotomy (SDR) – The SDR technique involves cutting some of the sensory nerve fibers that come from the muscles and enter the spinal cord. A five to six inch incision is made along the center of the lower back just above the waist in order to expose the nerves and locate the abnormal portions of nerve fiber that need to be cut. This allows better balance in the spinal cord and reduces spasms, but does require a commitment to physical therapy following treatment.