TY - JOUR
T1 - The effect of GMFCS level, age, sex, and dystonia on multi-dimensional outcomes after selective dorsal rhizotomy
T2 - prospective observational study
AU - Gillespie, Conor Scott
AU - George, Alan Matthew
AU - Hall, Benjamin
AU - Toh, Steven
AU - Islim, Abdurrahman Ismail
AU - Hennigan, Dawn
AU - Alder Hey Physiotherapy Group
AU - Kumar, Ram
AU - Pettorini, Benedetta
PY - 2021/2/18
Y1 - 2021/2/18
N2 - PURPOSE: Investigate the effect of age category (1-9 years vs 10-18 years), sex, Gross Motor Function Classification System (GMFCS) level, and presence of dystonia on changes in eight function test parameters 24 months after selective dorsal rhizotomy (SDR).METHODS: Prospective, single-center study of all children aged 3-18 years with bilateral cerebral palsy with spasticity who underwent SDR at a tertiary pediatric neurosurgery center between 2012 and 2019. A linear mixed effects model was used to assess longitudinal changes.RESULTS: From 2012 to 2019, 42 children had follow-up available at 24 months. Mean GMFM-66 scores increased after SDR (mean difference 5.1 units: 95% CI 3.05-7.13, p < 0.001). Statistically significant improvements were observed in CPQoL, PEDI Self-care and Mobility, 6MWT, Gillette, and MAS scores. There was no significant difference in the improvements seen for age category, sex, GMFCS level, and presence of dystonia for most of the parameters tested (5/8, 6/8, 5/8, and 6/8 respectively).CONCLUSION: SDR may improve gross and fine motor function, mobility and self-care, quality of life, and overall outcome based on extensive scoring parameter testing at 24 months. Atypical patient populations may benefit from SDR if appropriately selected. Multi-center, prospective registries investigating the effect of SDR are required.
AB - PURPOSE: Investigate the effect of age category (1-9 years vs 10-18 years), sex, Gross Motor Function Classification System (GMFCS) level, and presence of dystonia on changes in eight function test parameters 24 months after selective dorsal rhizotomy (SDR).METHODS: Prospective, single-center study of all children aged 3-18 years with bilateral cerebral palsy with spasticity who underwent SDR at a tertiary pediatric neurosurgery center between 2012 and 2019. A linear mixed effects model was used to assess longitudinal changes.RESULTS: From 2012 to 2019, 42 children had follow-up available at 24 months. Mean GMFM-66 scores increased after SDR (mean difference 5.1 units: 95% CI 3.05-7.13, p < 0.001). Statistically significant improvements were observed in CPQoL, PEDI Self-care and Mobility, 6MWT, Gillette, and MAS scores. There was no significant difference in the improvements seen for age category, sex, GMFCS level, and presence of dystonia for most of the parameters tested (5/8, 6/8, 5/8, and 6/8 respectively).CONCLUSION: SDR may improve gross and fine motor function, mobility and self-care, quality of life, and overall outcome based on extensive scoring parameter testing at 24 months. Atypical patient populations may benefit from SDR if appropriately selected. Multi-center, prospective registries investigating the effect of SDR are required.
KW - Cerebral Palsy/surgery
KW - Child
KW - Child, Preschool
KW - Dystonia
KW - Humans
KW - Infant
KW - Muscle Spasticity/surgery
KW - Prospective Studies
KW - Quality of Life
KW - Rhizotomy
KW - Treatment Outcome
U2 - 10.1007/s00381-021-05076-0
DO - 10.1007/s00381-021-05076-0
M3 - Article
C2 - 33599808
SN - 0256-7040
VL - 37
SP - 1729
EP - 1740
JO - Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
JF - Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
IS - 5
ER -