Sudden falls as a persistent complication of selective dorsal rhizotomy surgery in children with bilateral spasticity: report of 3 cases.

Selective dorsal rhizotomy (SDR) surgery is a well-established treatment for ambulatory children with bilateral spastic paresis and is performed to eliminate spasticity and improve walking. The objective of this case report is to describe sudden falls as a persistent complication of SDR. The authors report on 3 patients with bilateral spastic paresis, aged 12, 6, and 7 years at the time of surgery. The percentage of transected dorsal rootlets was around 40% at the L2-S1 levels. Sudden falls were reported with a frequency of several a day, continuing for years after SDR. The falls were often triggered by performing dual tasks as well as occurring in the transition from sitting to standing, during running, after strenuous exercise, or following a fright. Patients also had residual hyperesthesia and dysesthesia of the foot sole. The authors hypothesize that the sudden falls are caused by a muscle inhibition reflex of the muscles in the legs, as an abnormal reaction to a sensory stimulus that is perceived with increased intensity by a patient with hyperesthesia. A favorable effect of gabapentin medication supports this hypothesis.

The role of body weight, fat distribution and weight change in ethnic differences in the 9-year incidence of hypertension.

OBJECTIVE: To investigate the role of body composition (body weight, fat distribution and weight change over time) in ethnic differences in the incidence of hypertension in an ethnic Dutch, South Asian Surinamese and African Surinamese background population living in the Netherlands. METHODS: We included 361 participants without hypertension at baseline (147 ethnic Dutch, 82 South Asian Surinamese, 132 African Surinamese), aged 35-60 years, in whom anthropometric measurements and blood pressures were measured at baseline and after mean 9 years of follow-up. Data were analysed using logistic regression analyses, with hypertension at follow up as a dependent variable. RESULTS: Body weight, fat distribution and weight gain were positively associated with the risk of developing hypertension; these associations did not statistically significantly differ between ethnic groups [odds ratios (ORs), 95% confidence interval (95% CI) per SD: BMI 1.5 (1.2-2.0); waist circumference 1.5 (1.2-1.9); waist to hip ratio (WHR) 1.4 (1.1-1.9), weight gain of 1-2.9 kg/m 1.8 (0.9-3.8)]. As compared with Dutch, a higher incidence of hypertension was found among South Asian Surinamese [OR 2.6 (1.4-4.8)] and in particular among African Surinamese [OR 3.1 (1.76-5.30)]. Among South Asian Surinamese, adjustment for WHR attenuated the OR the most [OR 1.9 (1.0-3.7)]; among African Surinamese, the strongest effect was observed for adjustment by BMI and WHR simultaneously [OR 2.5 (1.4-4.4)]. CONCLUSION: The ethnic differences in the incidence of hypertension among a middle-aged group with a Dutch, South Asian Surinamese and African Surinamese background were partly explained by body composition. This suggests that other factors may be involved, including genetic factors or unidentified other determinants.