Skip to main content

Surgical Management of Functional Disorders

  • Chapter
  • First Online:
Nursing Care of the Pediatric Neurosurgery Patient

Abstract

This interesting and informative chapter provides an overview of the pathophysiology of movement disorders in children. Surgical management is discussed, including intrathecal pumps, deep brain stimulators (DBS), and dorsal rhizotomy. Nursing care and informative parental insights are presented.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 99.00
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Abbott R (1999). Selective dorsal rhizotomy. Retrieved August 16, 2005, from http://cerebnet.netfirms.com/selective.htm

  • Adams M, Hicks AL (2010) Spasticity: pathophysiology, assessment, and management. In: Lin VW (ed) Spinal cord medicine: principles and practice. Demos Medical Publishing, New York

    Google Scholar 

  • Albanese A, Barnes MP, Bhatia KP, Fernandez-Alvarez E, Fillipini G, Gasser T et al (2006) A systematic review on the diagnosis and treatment of primary (idiopathic) dystonia and dystonia plus syndromes: report of an EFNS/MDS-ES task force. Eur J Neurol 13(5):433–444. doi:10.1111/j.1468-1331.2006.01537.x

    Article  CAS  PubMed  Google Scholar 

  • Albanese A, Bhatis K, Bressman SB, Delong MR, Fahn A, Fung VSC et al (2013) Phenomenology and classification of dystonia: a consensus update. Mov Disord 28(7):863–873

    Article  PubMed  PubMed Central  Google Scholar 

  • Albright AL (2003) Neurosurgicaltreatment of spasticity and other pediatric movement disorders, J. chid Neurol 18:S67–S78

    Google Scholar 

  • Albright AL, Ferson SS (2006) Intrathecal baclofen therapy in children. Neurosurg Focus 21(2):1–6

    Article  Google Scholar 

  • Atiyeh BS, Hayek SN, Skaf GS, Araj AA, Chamoun RB (2006) Baclofen pump pocket infection: a case report of successful salvage with muscle flap. Int Wound J 3:23–28

    Article  PubMed  Google Scholar 

  • Awaad Y, Tayem H, Munoz S, Ham S, Michon AM, Awaad R (2003) Functional assessment following intrathecal Baclofen therapy in children with spastic cerebral palsy. J Child Neurol 18:26–34

    Article  PubMed  Google Scholar 

  • Awan NR, Lozano A, Hamani C (2009) Deep brain stimulation: current and future perspectives. Neurosurg Focus 27(1). doi:10.3171/2009.4.FOCUS0982

  • Barry MJ, Van Swearingen JM (1999) Reliability and responsiveness of the Barry-Albright Dystonia Scale. Dev Med Child Neurol 41(6):404–411

    Article  CAS  PubMed  Google Scholar 

  • Berardelli A, Rothwell JC, Hallett M, Thompson PD, Manfredi M, Marsden CD (1998) The pathophysiology of primary dystonia. Brain 121:1195–1212

    Article  PubMed  Google Scholar 

  • Bergenheim AT, Wendelius M, Shahidi S, Larsson E (2003) Spasticity in a child with myelomeningocele treated with continuous intrathecal Baclofen. Pediatr Neurosurg 39:218–221. doi:10.1159/000072476

    Article  PubMed  Google Scholar 

  • Boviatsis EJ, Kouyialis AT, Boutsikakis I, Korfas S, Sakas DE (2004) Infected CNS infusion pumps: is there a chance for treatment without removal? Acta Neurochir 146:463–467

    Article  CAS  PubMed  Google Scholar 

  • Camargo CH, Camargos ST, Cardoso FEC, Teive HAG (2015) The genetics of the dystonias – a review based on the new classification of the dystonias. Arq Neuropsiquiatr 73(4):350–358. doi:10.1590/0004-282XX20150030

    Article  PubMed  Google Scholar 

  • Center for Disease Control and Prevention; Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) The Hospital Infection Control Practice Advisory Committee. Guideline for prevention of surgical site infection. Infection control and Hospital Epidemiology 20(4):247–278

    Google Scholar 

  • Cheek WR (1996) Atlas of pediatric neurosurgery. W.B. Saunders Company, Philadelphia

    Google Scholar 

  • Comella CL, Leurgans S, Wuu J, Stebbins GT, The Dystonia Study Group (2003) Rating scales for dystonia: a multicenter assessment. Mov Disord 18(3):303–312

    Article  PubMed  Google Scholar 

  • Danner SM, Dimitrijevic MR (2012) Spasticity: pathophysiology and neural control. In: Kusimastuli P, Tular ABM (eds) 3rd Asia-Oceanian Conference of Physical and Rehabilitation Medicine in Conjunction with XI Annual Scientific of Indonesian Association of Physical Medicine and Rehabilitation. Medimond, Bologna ISBN978–88–7587-655-5, pp 9–15

    Google Scholar 

  • Dario A, Tomei G (2004) A benefit-risk assessment of Baclofen in severe spinal spasticity. Drug Saf 27(11):799–818

    Article  CAS  PubMed  Google Scholar 

  • Dario A, Scamoni C, Picano M, Fortini G, Cuffari A, Tomei G (2005) The infection risk of intrathecal drug infusion pumps after multiple refill procedures. Neuromodulation 8(1):36–39

    Article  PubMed  Google Scholar 

  • Dawes WJ, Drake JM, Fehlings D (2003) Microfracture of a baclofen pump catheter with intermittent under- and overdose. Pediatr Neurosurg 39(3):144–148

    Article  PubMed  Google Scholar 

  • Dietz V (2000) Spastic movement disorder. Spinal Cord 38:389–393

    Article  CAS  PubMed  Google Scholar 

  • DiFrancesco MF, Halpern CH, Hurig HH, Raltuch GH, Heuer GG (2012) Pediatric indications for deep brain stimulation. Childs Nerv Syst 28:1701–1714

    Article  PubMed  Google Scholar 

  • Douglas AF, Weiner HL, Schwartz DR (2005) Prolonged intrathecal baclofen withdrawal syndrome. J Neurosurg 102:1133–1136

    Article  PubMed  Google Scholar 

  • Fenoy AJ, Simpsons R (2014) Risks of common complication in deep brain stimulation surgery: management and avoidance. J Neurosurg 120:132–139

    Article  PubMed  Google Scholar 

  • Fitzgerald JJ, Tsegaye M, Vloeberghs (2004) Treatment of childhood spasticity of cerebral origin with intrathecal Baclofen: a series of 52 cases. Br J Neurosurg 18(3):240–245

    Article  CAS  PubMed  Google Scholar 

  • Follett KA, Burchiel K, Deer T, Dupen S, Prager J, Turner MS et al (2003) Prevention of intrathecal drug delivery catheter-related complications. Neuromodulation 6(1):32–41

    Article  PubMed  Google Scholar 

  • Geyer HL, Bressman SB (2006) The diagnosis of dystonia. Lancet Neurol 5(9):780–790. doi:10.1016/S1474-4422(06)70547-6

    Article  PubMed  Google Scholar 

  • Goldstein EM (2001) Spasticity management : an overview. J Child Neurol 16:16–23

    Google Scholar 

  • Gooch JL, Oberg WA, Grams B, Ward LA, Walker ML (2003) Complications of intrathecal Baclofen pumps in children. Pediatr Neurosurg 39:1–6

    Article  PubMed  Google Scholar 

  • Grunt S, Becher JG, Vermeulen RJ (2011) Long-term outcome and adverse effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review. Dev Med Child Neurol 53:490–498. doi:10.1111/j.469-8749.2011.03912.x

    Article  PubMed  Google Scholar 

  • Guettard E, Roze E, Abada G, Lemesle C, Vidailhet M, Laurent-Vannier A et al (2009) Management of spasticity and dystonia in children with acquired brain injury with rehabilitation and botulinum toxin A. Dev Neurorehabil 12(3):128–138. doi:10.1080/17518420902927994

    Article  PubMed  Google Scholar 

  • Haranhalli N, Amnand D, Wisoff JH, Harter DH, Weiner HL, Blate M, Roth J (2010) Intrathecal baclofen therapy: complication avoidance and management. Childs Nerv Syst 27:421–427. doi:10.1007/s00381-010-1277-9

    Article  PubMed  Google Scholar 

  • Hays RM, McLaughlin JF, Geiduschek JM, Bjornson KF,Graubert CS (1997) Evaluation of the effects of selective dorsal rhizotomy. Mental retardation and Development Disabilities Research Reviews, 3:168–174

    Google Scholar 

  • Hippard HK, Watcha M, Stocco AJ, Curry D (2014) Preservation of microelectrode recordings with non-GABAergic drugs during deep brain stimulator placement in children. J Neurosurg Pediatr 14:279–286

    Article  PubMed  Google Scholar 

  • Hesselgard K, Reinstrup P, Stromblad LG, Unden J, Romner B (2005) Selective dorsal rhizotomy and postoperative pain management. Pediatr Neurosurg 43:107–112. doi:10.1159/000098382

    Article  Google Scholar 

  • Institute for Neurology & Neurosurgery (2004). Rhizotomy. Retrieved August 16, 2005, from http://nyneruosurgery.org/cp/thizhist.html

  • Keen JR, Przekop A, Olaya JE, Zouros A, Hsu FP (2014) Deep brain stimulation for the treatment of childhood dystonic cerebral palsy. J Neurosurg Pediatr 14(6):585–93. doi:10.3171/2014.8.PEDS141

  • Keenan E (2010) Spasticity management, Part 3: surgery and the use of intrathecal baclofen. Br J Neurosci Nurs 6(1):12–18

    Article  Google Scholar 

  • Kenney C, Simpson R, Hunter C, Ondo W, Almaguer M, Davidson A, Jankovic J (2007) Short-term and long-term safety of deep brain stimulation in the treatment of movement disorders. J Neurosurg 106:621–625

    Article  PubMed  Google Scholar 

  • Krach LE, Kriel R, Day SM, Strauss DJ (2009) Survival of individual with cerebral palsy receiving continuous intrathecal baclofen treatment: a matched-cohort study. Dev Med Child Neurol 52:672–676. doi:10.1111/j.1469-8749.2009.03473.x

  • Koman LA, Smith B, Balkrishnan (2003) Spasticity associated with cerebral palsy in children. Pediatr Drug 5(1):11–23

    Article  Google Scholar 

  • Larson PS, Richardson RM, Starr PA, Martin AJ (2008) Magnetic resonance imaging of implanted deep brain stimulators: experience in a large series. Stereotact Funct Neurosurg 28:92–100

    Google Scholar 

  • Lipsman N, Ellis M, Lozano AM (2010) Current and future indications for deep brain stimulation in pediatric populations. Neurosurg Focus 29(2):1–7

    Article  Google Scholar 

  • Lubarr N, Bressman S (2010) Advances in our understanding of dystonia – pathophysiology and treatment outcome. US Neurol 6(2):115–121. doi:10.17925/USN.2010.06.02.115

    Article  Google Scholar 

  • Madhusudanan M (1999) Dystonia: emerging concepts in pathophysiology. Neurol India 47:263

    CAS  PubMed  Google Scholar 

  • MacWilliam BA, Johnson BA, Shuckra AL, D’Astous JL (2011) Functional decline in children undergoing selective dorsal rhizotomy after age 10. Dev Med Child Neurol 53:717–723. doi:10.1111/j.1469-8749.2011.04010.x

    Article  Google Scholar 

  • Martins A (2016) The role of spasticity in functional neurorehabilitation – Part 1: the pathophysiology of spasticity, the relationship with neuroplasticity, spinal shock and clinical signs. Arch Medication 8(3):1–7

    Google Scholar 

  • Martin AJ, Larson PS, Ziman N, Levesque N, Volz M, Ostrem JL, Starr PA (2016) Deep brain stimulator implantation in a diagnostic MRI suite: infection history over a 10-year period. J Neurosurg, Published online March 25, 2016; doi:10.3171/2015.7.JNS15750

  • Medtronic Inc (2015) MRI guidelines for Medtronic deep brain stimulation systems, 2014-12-01 - instructions for use. http://www.zaloker-zaloker.si/assets/Uploads/MR-smernice.pdf

  • Mohammed I, Hussain A (2004) Intrathecal baclofen withdrawal syndrome – a life-threatening complication of baclofen pump: a case report. BMC Clin Pharmacol 4(6):1–5. doi:10.1186/1472-6904-4-6

    Google Scholar 

  • Morton RE, Gray N, Vloeberghs M (2011) Controlled study of the effects of continuous intrathecal baclofen infusion in non-ambulant children with cerebral palsy. Dev Med Child Neurol 53:736–741. doi:10.1111/j1469-8749.2011.04009.x

    Article  PubMed  Google Scholar 

  • Moss SD, Manwaring KH (1992) Relief of spasticity for children with cerebral palsy using selective posterior rhizotomy. Phoenix Child Hosp Pediatr Rev 4(1):5–11

    Google Scholar 

  • Motta F, Buonaguro V, Stignani C (2007) The use of intrathecal baclofen pump implants in children and adolescents: safety and complications in 200 consecutive cases. J Neurosurg 107:32–35. doi:10.3171/PED-07/07/032

    PubMed  Google Scholar 

  • Mullarkey T (2009) Considerations in the treatment of spasticity with intrathecal baclofen. Am J Health-Syst Pharm 66(Suppl. 5):s14–s22. doi:10.2146/ajhp0108c

    Article  CAS  PubMed  Google Scholar 

  • Kumura A, Kidokoro H, Shoji H, Nakazawa T, Mimaki M, Fujil K et al (2009) Kernicterus in preterm infants. Pediatrics 123:1052–1058. doi:10.1542/peds.2008.2791

    Article  Google Scholar 

  • Olaya JE, Christian E, Ferman D, Luc Q, Krieger MD, Sanger TD, Liker MA (2013) Deep brain stimulation in children and young adults with secondary dystonia: the Children’s Hospital Los Angeles experience. Neurosurg Focus 35(5):1–13

    Article  Google Scholar 

  • Ou C, Kent S, Miller S, Steinbok P (2010) Selective dorsal rhizotomy in children: comparison of outcomes after single-level versus multi-level laminectomy technique. Can J Neurosci Nurs 32(3):17–24

    PubMed  Google Scholar 

  • Pin TW, McCartney L, Lewis J, Waugh M (2011) Use of intrathecal baclofen therapy in ambulant children and adolescents with spasticity and dystonia of cerebral origin: a systematic review. Dev Med Child Neurol 53:885–895. doi:10.1111/j.1469-8749.2011.03992.x

    Article  PubMed  Google Scholar 

  • Plassat R, Verbe BP, Menei P, Menegalli D, Mathe JF, Richard I (2004) Treatment of spasticity with intrathecal Baclofen administration: long-term follow-up, review of 40 patients. Spinal Cord 42:686–693

    Article  CAS  PubMed  Google Scholar 

  • Priori F, Cogiamanian f, sPposta SM (2006)Pathophysiology of spasticity. Vol 27 supplement 4, s307–s309

    Google Scholar 

  • Ramstad K, Jahnsen R, Lofterod B, Skjeldal OH (2010) Continuous intrathecal baclofen therapy in children with cerebral palsy – when does improvement emerge? Acta Paediatr 99:1661–1665. doi:10.1111/j.1651-2227.2009.01596x

    Article  CAS  PubMed  Google Scholar 

  • Rekand T (2010) Clinical assessment and management of spasticity: a review. Acta Neurol Scand Suppl (190):62–66. doi:10.1111/j.1600-0404.2010.01378.x

  • Roubertie A, Echonne B, Cif L, Vayssiere N, Hemm S, Coubes P (2000) Treatment of early-onset dystonia: update and a new perspective. Childs Nerv Syst 16:334–340

    Article  CAS  PubMed  Google Scholar 

  • Ridley B, Rawlins PK (2006) Intrathecal baclofen therapy: ten steps toward best practice. J Neurosci Nurs 38(2):72–82

    Article  PubMed  Google Scholar 

  • Rizzo MA, Hadjimichael OC, Preinigherova J, Vollmer TL (2004) Prevalence and treatment of spasticity reported by multiple sclerosis patients. Mult Scler 10:589–595

    Article  CAS  PubMed  Google Scholar 

  • Rose J, Vassar R (2015) Movement disorders due to bilirubin toxicity. Semin Fetal Neonatal Med 20(1):20–25. doi:10.1016/j.siny.2014.11.002

    Article  PubMed  Google Scholar 

  • Satkunam LE (2003) Rehabilitation medication: 3. Management of adult spasticity. CMAJ 169(11):1173–1179

    Google Scholar 

  • Sheean G (2002) The pathophysiology of spasticity. Eur J Neurol 9(Suppl. 1):3–9

    Article  PubMed  Google Scholar 

  • Stallings VA, Cronk CE, Zemel BS, Charney EB (1995) Body composition in children with spastic quadriplegic cerebral palsy. J Pediatr 126:833–839

    Article  CAS  PubMed  Google Scholar 

  • Steinbok P (2006) Selection of treatment modalities in children with spastic cerebral palsy. Neurosurg Focus 21(2):1–8. doi:10.317/foc.2006.21.2.5

    Google Scholar 

  • Steinbok P, Tidemann AJ, Miller S, Mortenson P, Bowen-Roberts T (2009) Electrophysiologically guided versus non-electrophysiologically guided selective dorsal rhizotomy for spastic cerebral palsy: a comparison of outcomes. Childs Nerv Syst 25:1091. doi:10.1007/s00381-009-0908-5

    Google Scholar 

  • Tabbal SD (2015) Childhood dystonias. Curr Treat Options Neurol 17(12):1–15. doi:10.1007/s11940-015-0339-4

    Google Scholar 

  • Tedroff K, Lowing K, Jacobson DN, Astrom E (2011) Does loss of spasticity matter? a 10-yer follow-up after selective dorsal rhizotomy in cerebral palsy.Dev Med Child Neurol. 53(8):724–729, doi:10.1111/j.1469-8749-2011.03969.x

  • Tempel LW, Perlmutter JS (1993) Abnormal cortical responses in patients with writer’s cramp. Neurology 43:2252–2257

    Article  CAS  PubMed  Google Scholar 

  • Thompson AJ, Jarrett L, Lockley L, Marsden J, Stevenson VL (2005) Clinical management of spasticity. J Neurol Neurosurg Psychiatry 76:459–463. doi:10.1136/jnnp.2004.035972

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Trompetto C, Marinelli L, Mori L, Pelosin E, Curra A, Molfetta L, Abbruzzes G (2014) Pathophysiology of spasticity - implication for neurorehabilitation. BioMed Research International. Volume 2014, http://dx.doi: org/10.1155/2014/354906

    Google Scholar 

  • Vanek ZF, Menkes JH, Carcione J, Talavera F, Lopate G, Benbadis S, Berman SA (2010) Spasticity. eMedicine Neurology. Retrieved January 21, 2012, from http://www.emedicine.com/neuro/topic706.htm

  • Vayssiere N, Hemm S, Zancel M, Picot MC, Bonafe A, Cif L et al (2000) Magnetic resonance imaging stereotactic target localization for deep brain stimulation in dystonic children. J Neurosurg 93:784–790

    Article  CAS  PubMed  Google Scholar 

  • Vender LR, Hester S, Rekito A, Lee MR (2005) Baclofen intrathecal pump delivery systems, avoidance and management of complications in adult and pediatric patients: part 2. Contemp Neurosurg 27(2):1–5

    Article  Google Scholar 

  • Verceuil L, Krack P, Pollak P (2002) Results of deep brain stimulation for dystonia: a critical reappraisal. Mov Disord 17(S3):S89–S93. doi:10.1002/mds.10148

    Article  Google Scholar 

  • Vitztum C, Olney B (2000) Intrathecal baclofen therapy and the child with cerebral palsy. Orthop Nurs 19(1):43–48

    Article  CAS  PubMed  Google Scholar 

  • Ward A, Hayden S, Dexter M, Scheinberg (2009) Continuous intrathecal baclofen for children with spasticity and/or dystonia: goal attainment and complications associated with treatment. J Paediatr Child Health 45:72–726. doi:10.1111/j.1440-1754.2009.01601.x

    Article  Google Scholar 

  • Ward AB, Molenaers G, Colosimo C, Berardelli A (2006) Clinical value of botulinum toxin in neurological indications. Eur J Neurol 13(Suppl. 4):20–26

    Article  PubMed  Google Scholar 

  • Watve SV, Sivan M, Raza WA, Jamil FF (2012) Management of acute overdose or withdrawal state in intrathecal baclofen therapy. Spinal Cord 50:107–111

    Article  CAS  PubMed  Google Scholar 

  • Wong V (2003) Evidence-based approach of the use of botulinum toxin A (BTX) in cerebral palsy. Pediatr Rehabil 6(2):85–96. doi:10.1080/1363849031000139306

    Article  PubMed  Google Scholar 

  • Yam WKL, Leung MSM (2006) Interrater reliability of modified Ashworth scale and modified Tardieu Scale in children with spastic cerebral palsy. J Child Neuol. 21:1031–1035. doi:10.23107010.2006.00222

    Google Scholar 

  • Yu H, Neimat JS (2008) The treatment of movement disorders by deep brain stimulation. 89u. J Am Soc Exp Neurother 5:26–36

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Herta Yu RN, MN, CNN(C), NP-Paeds .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Yu, H. (2017). Surgical Management of Functional Disorders. In: Cartwright, C., Wallace, D. (eds) Nursing Care of the Pediatric Neurosurgery Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-49319-0_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-49319-0_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-49318-3

  • Online ISBN: 978-3-319-49319-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics