Spinal cord stimulation for the relief of spasticity from cerebral palsy

Abstract

Cerebral palsy (CP) is the most common form of childhood disability, and spasticity is the most common motor-manifestation. Thankfully, there has been a significant reduction in the percentage of children born with CP in recent years, but nonetheless, those afflicted children can face life long devastating disabilities. Spinal cord stimulation (SCS), an implanted device used to treat chronic neuropathic pain, has been used to treat children with spasticity. In some cases, it has been shown to produce a remarkable improvement but despite this, the technique is not commonly used. There are a number of case series, and retrospective reports of outcomes with the most successful demonstrating a nearly 1.5-point reduction in Ashworth scale, the least successful demonstrating no significant improvements. Here, the authors examine the clinical reports and propose a mechanism of action based on the current understanding of SCS. Technology development in SCS for pain management has progressed significantly since the early clinical experience with CP and some of the new technology may be able to better exploit the putative mechanism. The advent of compound action potential recording and closed-loop control could lead to new insights into the electrophysiology and how to better tune these devices to provide more substantial relief from symptoms.

Keywords

• bioelectric potentials
• neurophysiology
• paediatrics
• medical disorders
• patient treatment
• cerebral palsy
• childhood disability
• spasticity
• afflicted children
• spinal cord stimulation
• implanted device
• 1.5-point reduction
• clinical reports
• pain management
• early clinical experience
• motor-manifestation
• chronic neuropathic pain treatment
• ashworth scale
• compound action potential recording
• closed-loop control
• electrophysiology