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.
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