Currently, the most commonly performed neurosurgical procedures for the treatment of spasticity are selective dorsal rhizotomy and the placement of programmable pumps for chronic intrathecal baclofen infusion. Successful clinical outcomes are possible with careful patient selection and close cooperation between the surgeon, pediatrician and physical and occupational therapists. The goal is improvement in function or comfort, or reduction in pain or the development of contractures. Caution and precise technique are paramount, particularly with ablative procedures, because of the potential for creating new or exacerbating existing neurological deficits.

Because of developmental issues, early and aggressive control of seizure disorders is warranted in children. Intellectual, psychosocial and behavioral development is hindered while seizure disorders persist. During adolescence, seizure disorders have profound social implications, particularly on issues related to employment and drivers' licenses. These issues are best managed through proper classification and localization of seizure foci, and through knowledge of all available medical and surgical options.

Suggested Readings

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2. Albright AL. Spasticity and movement disorders. In: Albright AL, Pollack IF, Adelson PD, eds. Principles and Practice of Pediatric Neurosurgery. New York: Thieme, 1999.

3. Arens LJ, Peacock WJ, Peter J. Selective posterior rhizotomy: a long term follow-up study. Childs Nerv Syst 1989; 5:148-152.

4. Lazorthes Y, Sallerin-Caute B, Verdi J et al. Chronic intrathecal baclofen administration for control of severe spasticity. J Neurosurg 1990; 72:393-402.

5. Luders HO, Comair YG, eds. Epilepsy Surgery. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2001.

6. Ordia JI, Fischer E, Adamski E et al. Chronic intrathecal delivery of baclofen by a programmable pump for the treatment of severe spasticity. J Neurosurg 1996;


7. Peacock WJ, Arens LJ, Berman B. Cerebral palsy spasticity. Selective posterior rhizotomy. Pediatr Neurosci 1987; 13:61-66.

8. Pellock JM, Dodson WE, Bourgeouis BFD, eds. Pediatric Epilepsy, Diagnosis and Therapy. 2nd ed. New York: Demos Medical Publishing, 2001.

9. Smyth MD, Peacock WJ. The surgical treatment of spasticity. Muscle Nerve 2000; 23(2):153-163.

10. Young RR, Delwaide PJ. Drug therapy: Spasticity. First of two parts. N Engl J Med 1981; 304:96-99.

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