Spacticity

Spasticity is one of the commonest sequelae of many neurological disorders like stroke, cerebral palsy, multiple sclerosis, trauma etc. At present only medical treatment for spasticity in form of oral medications and Botulinum Toxin injections are available at most of the centers including our hospital. This is complemented by orthopedic interventions, intensive physiotherapy and rehabilitation. However, large numbers of patients have significantly residual spasticity for which there is no remedy.

Neurosurgical treatment for spasticity aims at providing relief to these patients. Surgical procedures like Neurotomies, Rhiozotomies, Intrathecal Baclofen combined with Orthopaedic interventions can be undertaken for the treatment of spasticity. Jaslok Hospital is the only center in India that deals with comprehensive surgical management of spasticity.

Neurotomy: It involves resecting part of the motor nerve responsible for spasticity, for e.g. median nerve, tibial nerve etc. It is useful in improving management of hemiplegic patients.

Dorsal Root entry zone lesion: DREZotomy is indicated in patients with paraplegia and severe pain. It not only relieves the spasticity but also alleviates pain.

a) Adductor spasticity before surgery	b) Impaired range of movement after surgery

Selective Functional Dorsal Rhizotomy: In patients suffering from spasticity with preserved power, this surgery is indicated. It is most useful in cerebral palsy patients as it can selectively resect dorsal roots contributing to spasticity without affecting the motor power, thus improving their mobility.

Intrathecal Baclofen Pump: ITB therapy, as it is popularly known, aims at delivering Baclofen intrathecally with an aim to reduce spasticity. The direct Intrathecal deliver allows us to drop the dose to a fraction of the oral dosage. The pump can be programmed by an external computer to allow therapy to be tailored to individual requirements.

a) Severe spasticity and dystonia before Intrathecal Baclofen Trial (Note: The arching of upper and lower body

b) 4 hours Post Trial: Complete relaxation, Increased freedom of movements