Selective Dorsal Rhizotomy Offers Promise for Children With Cerebral Palsy
Cerebral palsy is a complex medical condition that occurs as the result of oxygen deprivation to the brain, most often during pregnancy or childbirth. However, it can also occur during the first few years of a child’s life. For any number of reasons, a part of the brain may not receive enough oxygen, which leads to damage in the parts of the brain that control motor movements and speech.
As a child grows, the muscles may not develop properly. Often, parents notice issues in a child with cerebral palsy within the first few months of life. A parent may notice that their child fails to meet expected motor milestones, or they might appear exceptionally stiff or floppy, indicating an issue with muscle tone. As a child gets older, he or she may complain of stiffness or pain in their limbs because of muscle spasticity or hypertonia.
Many children with a diagnosis of cerebral palsy have difficulty doing simple activities. Even something as simple as writing to complete school assignments can prove to be a Herculean task. Children with cerebral palsy may also experience difficulties seeing, hearing, and speaking.The Main Types of Cerebral Palsy
Several types of cerebral palsy exist:
- Spastic cerebral palsy leads to stiffness in the limbs and leads to difficulties with agility. Depending on the extent of the condition, some children are unable to walk without orthotic devices or additional support.
- Athetoid cerebral palsy makes it difficult for children to control their motor movements, and they may experience involuntary movements of their limbs.
- Ataxic cerebral palsy affects depth perception and balance in affected children. These children may have low muscle tone and experience difficulty performing everyday tasks, such as walking or gripping a pencil.
Several other forms of cerebral palsy exist and they may be mild, moderate, or severe. Cerebral palsy is typically spastic (indicating hypertonia, or high muscle tone) or non-spastic (featuring hypotonia or fluctuating muscle tone). No universal classification system for the condition exists, and parents learn that medical professionals use different terms to define similar problems.Treatments for Cerebral Palsy
Unfortunately, no cure for cerebral palsy exists. As such, current medical interventions focus on enhancing a child’s quality of life. Interventions may be rehabilitative in the form of speech, occupational, or physical therapy. On the other hand, they may also be surgical. One of the most common surgical interventions aimed at improving the quality of life in children with cerebral palsy is a selective dorsal rhizotomy (SDR).
This procedure is one of the most well researched and actively used surgeries for children with a diagnosis of CP. The SDR focuses on separating problematic nerve roots that children with CP have, which lead to spastic movements. Medical professionals have used this technique since the 1980s, and it still provides an enhanced quality of life for those children who struggle with the effects of CP.
First, a neurosurgeon identifies the nerves that are responsible for spastic movements. They test each nerve end with electromyography, a technique that allows them to isolate the problematic nerves roots. Once they isolate and separate the nerves from the functional ones, the surgeon destroys them.
SDR, when effective, helps vastly improve the quality of life for both children and parents living with cerebral palsy. Thanks to procedures like SDR, children have been able to take their first steps or walk without walkers or other assistive devices. However, SDR does have certain downsides, such as:
- High out-of-pocket cost. Even with insurance, the cost of an SDR procedure may be very expensive. In some cases, insurers won’t approve the procedure, stating the rehabilitative services such as physical therapy are a better way to go.
- Even after surgery, a child may require intensive physical therapy to “waken” the muscles that have been hypertonic for so long. Even after the procedure is over, children can expect a long battle to regain control over their muscles.
- Only large hospitals offer the procedure, so some families may have to travel long distances or out of network to receive the treatment that the child needs.
- The surgery also has possible complications and side effects. Children may experience neuropathy, sensory dysfunction, temporary issues with bladder control, and an increased risk of intraoperative asthma attacks in at-risk patients.
A selective dorsal rhizotomy can help a child affected by cerebral palsy make great gains in motor movement and controlling spasticity. It can help children with severe cerebral palsy take their first steps, and increase the range of motion in children with less severe forms of the disorder. However, parents should thoroughly consider the risks and benefits of the procedure, as well as discuss them with their doctors. While the SDR may be intensive and require months of therapy, many parents and their children find it well worth the effort and cost involved.