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Cerebral Palsy and Spasticity

What is cerebral palsy?

Cerebral palsy (CP) is a condition that affects muscle movement. It is usually caused by damage to one or more areas of the brain.

CP affects one to two children per 1,000 live births. It does not get better or worse over time.

Spasticity

A significant number of children with CP have constantly stiff and rigid muscles. They also have increased reflexes they cannot control — this is called spasticity. Movement is very difficult and often awkward for these children.

Spasticity leads to permanently tight muscles and joints (contractures). Children with spasticity may also have the following:

Dystonia

Dystonia is a movement disorder with uncontrollable tightening of the muscles. Jerking or twisting movements occur sporadically and are random, meaning they have no pattern.

Athetosis

Though the movements are smoother than dystonia, this disorder involves continuous movement marked by twisting and rolling movements (writhing) of the fingers, hands and toes.

Who gets cerebral palsy?

CP is most often seen when a baby is premature. Known causes include:

  • Lack of oxygen to the brain, called anoxic injury
  • Physical injury to the brain or spinal cord
  • Infections

Some children have CP without any obvious cause.

What is your experience with cerebral palsy?

Children’s has a great deal of experience caring for children with CP. We see children in our Neurodevelopmental Clinic, where experts from different specialties come together to treat and manage CP and spasticity.

Some treatments involve surgery. Our neurosurgeons have placed (implanted) baclofen pumps in more than 175 children and provide follow-up care to about half of them. The pumps continuously and automatically provide these children with medicine.

We also have done many rhizotomies, a surgery that can permanently alter a child’s spasticity by cutting certain nerves in the spine.

Screening

We screen children in the Neurodevelopmental Clinic to find out who can receive a baclofen pump or a dorsal rhizotomy.

What surgery do you use to treat cerebral palsy?

Neurosurgeons at Children’s do two surgeries to lessen your child’s spasticity.

1. Baclofen pump

This is a pump intended to relieve your child’s uncontrollable muscle reflexes. The medication provides her body with a constant dose of a medicine called baclofen.

The pump is about the size of a hockey puck, more or less three inches around and one inch thick. It is put in (implanted) under the skin of the stomach area (abdomen).

Before surgery

Before we actually put in (implant) the pump, we give your child a test dose of baclofen into her spinal cord with a needle. This procedure is called a lumbar puncture. We do this to be sure that baclofen is the right medicine for her system.

After the procedure, a physical therapist watches your child for several hours to see what effect the medicine has on her body.

The surgery

If the neurosurgeon and your family agree that your child can benefit from a baclafen pump, her neurosurgeon will surgically implant one. The surgery involves putting the baclafen pump under the skin of your child’s stomach (abdomen) area.

Next, her neurosurgeon attaches a thin tube (catheter) to the pump. He threads the catheter around her body under the skin to her spine at waist level. Then, he inserts the catheter into and up the spinal canal.

Our team fills the pump with baclofen and sets it to deliver the exact amount of medicine your child needs. The pump begins slowly pumping the medicine into the spinal canal to make the child’s muscles less spastic.

The baclofen pump must be filled with medicine every one to six months, depending on your child’s dose. You can refill it at Children’s or at an outside facility if you have one nearby.

The pump lasts about five years and then needs to be surgically removed and replaced.

The pump can never be allowed to run out of baclofen due to extremely harmful effects on the child should this happen.

2. Selective dorsal rhizotomy

During this operation, the neurosurgeon exposes the nerve roots in your child’s lower spinal canal that go to her leg muscles. He cuts about 30-50 percent of the sensory nerves. This surgery can permanently change your child’s spasticity. After this surgery the child needs a lot of physical therapy.