History and evolution of surgical treatment for spasticity: a journey from neurotomy to selective dorsal rhizotomy.

The evolution of neurosurgical approaches to spasticity spans centuries, marked by key milestones and innovative practitioners. Probable ancient descriptions of spasmodic conditions were first classified as spasticity in the 19th century through the interventions of Dr. William John Little on patients with cerebral palsy. The late 19th century witnessed pioneering efforts by surgeons such as Dr. Charles Loomis Dana, who explored neurotomies, and Dr. Charles Sherrington, who proposed dorsal rhizotomy to address spasticity. Dorsal rhizotomy rose to prominence under the expertise of Dr. Otfrid Foerster but saw a decline in the 1920s due to emerging alternative procedures and associated complications. The mid-20th century saw a shift toward myelotomy but the revival of dorsal rhizotomy under Dr. Claude Gros' selective approach and Dr. Marc Sindou's dorsal root entry zone (DREZ) lesioning. In the late 1970s, Dr. Victor Fasano introduced functional dorsal rhizotomy, incorporating electrophysiological evaluations. Dr. Warwick Peacock and Dr. Leila Arens further modified selective dorsal rhizotomy, focusing on approaches at the cauda equina level. Later, baclofen delivered intrathecally via an implanted programmable pump emerged as a promising alternative around the late 1980s, pioneered by Richard Penn and Jeffrey Kroin and then led by A. Leland Albright. Moreover, intraventricular baclofen has also been tried in this matter. The evolution of these neurosurgical interventions highlights the dynamic nature of medical progress, with each era building upon and refining the work of significant individuals, ultimately contributing to successful outcomes in the management of spasticity.

What constitutes cerebral palsy in the twenty-first century?

AIM: Determining inclusion/exclusion criteria for cerebral palsy (CP) surveillance is challenging. The aims of this paper were to (1) define inclusion/exclusion criteria that have been adopted uniformly by surveillance programmes and identify where consensus is still elusive, and (2) provide an updated list of the consensus concerning CP inclusion/exclusion when a syndrome/disorder is diagnosed. METHOD: Data were drawn from an international survey of CP registers, the New South Wales CP Register (1993-2003), the Western Australian CP Register (1975-2008), and the Surveillance of CP in Europe (SCPE; 1976-1998). An expert panel used a consensus building technique, which utilized the SCPE 'decision tree' and the original 'What constitutes cerebral palsy?' paper as frameworks. RESULTS: CP surveillance programmes agree on key clinical criteria pertaining to the type, severity, and origin of motor disorder in CP. Further work is warranted to reach agreement for (1) minimum age of survival and maximum age of postneonatal brain injury, and (2) metabolic disorders with highly variable clinical courses/responses to treatment. One hundred and ninety-seven syndromes/disorders were reviewed and advice on their inclusion/exclusion is provided. INTERPRETATION: What constitutes CP will continue to evolve as diagnostics improve. Surveillance programmes throughout the world are committed to addressing their differences regarding inclusion/exclusion criteria for the umbrella term CP.

Biographical sketch: William John Little, FRCS (1810-1894).

This biographical sketch on William Little corresponds to the historic text, The Classic: Hospital for the Cure of Deformities: Course of Lectures on the Deformities of the Human Frame (1843), available at DOI 10.1007/s11999-012-2302-y .

The classic: Hospital for the cure of deformities: course of lectures on the deformities of the human frame. 1843.

This Classic Article is a reprint of the original work by W.J. Little, Hospital for the Cure of Deformities: Course of Lectures on the Deformities of the Human Frame. An accompanying biographical sketch of W.J. Little is available at DOI 10.1007/s11999-012-2301-z . The Classic Article is ©1843 and is reprinted courtesy of Elsevier from Little WJ. Hospital for the Cure of Deformities: course of lectures on the deformities of the human frame. Lancet. 1843;41:350-354.

The understanding and operative treatment of cerebral palsy at the turn of the twentieth century: Harvey Cushing's early forays into pediatric neurosurgery.

INTRODUCTION: At the turn of the twentieth century, cerebral palsy and its treatment were not well understood, and a variety of treatment modalities were tested with only limited success. MATERIAL AND METHODS: Following IRB approval and through the courtesy of the Alan Mason Chesney Archives, we reviewed the Johns Hopkins Hospital surgical files from 1896-1912. Eight patients who received a diagnosis consistent with cerebral palsy and were treated surgically by Dr. Cushing were selected for further analysis and are described here. RESULTS: A total of eight patients underwent operative intervention for treatment of symptoms consistent with cerebral palsy. Of these, seven were male; the mean age was 4.9 years (range, 1.5 to 12). Five patients underwent decompressive craniotomies, one underwent tenotomies, one underwent transection of the spinal nerve roots, and one underwent primary transection of the spinal nerve roots with secondary tenotomies. Four representative cases are reported here. CONCLUSIONS: Cushing's contributions to pediatric neuro-oncology have been previously described, but his endeavors in non-oncologic realms remain largely unknown. Although Cushing employed previously described operative approaches for the treatment of cerebral palsy, parents brought their children to him from across the nation, in an era when long distance travel was tedious, and a financial burden. These cases serve to emphasize Cushing's interest in improving patient quality of life, and his broad contributions to pediatric neurosurgery.

Adaptive Sports, Arts, Recreation, and Community Engagement.

Adaptive sports and recreation have an important role in the lifestyle of individuals with cerebral palsy (CP). This article discusses the history of adaptive sports and the benefits of adaptive sports and recreation. Barriers and medical challenges are also thoroughly discussed, including common musculoskeletal issues, methods to prevent musculoskeletal injury, pain, fatigue, maximal exertion, and other medical comorbidities and illness. The role of health care providers such as physiatrists is emphasized to provide support to individuals with CP who either are interested in starting exercise or a sport or are already an athlete.

Cerebral palsy in the 21st century: is there anything left to say?

In April 2009 I was honoured to be asked to present the Emil Becker Lecture at the 35 (th) annual meeting of the German-Swiss-Austrian Society for Neuropaediatrics (Gesellschaft für Neuropädiatrie). Focusing on my interest and involvement as a clinician and researcher in cerebral palsy, I took the opportunity to look both back at the past 35 years and forward to what I believe are some of the important clinical challenges that are still to be addressed and solved in the 21 (st) century. This paper is therefore a personal reflection rather than a comprehensive review of the literature in cerebral palsy. It is my hope that these reflections will be of interest to others.

The construction of cerebral palsy definition: a historical journey to the present. / [La construcción de la definición parálisis cerebral: un recorrido histórico hasta la actualidad.]

Introduction: The definition of cerebral palsy (CP) has been difficult over the years mainly because of the large number of manifestations and concomitant diseases that can occur, taking unique characteristics in each subject that suffers. Method: This work seeks to reconstruct the historical course of cerebral palsy in order to relate it to the current challenges that arise in the area of public health for its approach. For this, a bibliographic review work was carried out in digital databases based on keywords. A literature search was performed using the data bases of MEDLINE (PubMed), SCOPUS, LILACS and Google Scholar. Texts were included in both English and Spanish. Results: It describes in the work different definitions that the PC takes from the nineteenth century to its current international definition agreed in 2005. More than 150 years took a long time to establish a definition demonstrating the complexity involved. The contributions of the International Classification of Functionality and Health (CIF) currently bring new challenges in the treatment. Conclusions: Knowing the history of the PC definition by relating it to changes in the disability paradigm allows us to analyze the complexity of the situation and calls for reflection on our health practices.

Introducción: La definición de la parálisis cerebral (PC) ha sido dificultosa a lo largo de los años principalmente por el gran número de manifestaciones y enfermedades concomitantes que puede presentar, tomando características únicas en cada sujeto que la padece. Método: Este trabajo buscó reconstruir el recorrido histórico de la parálisis cerebral para poder relacionarlo a los desafíos actuales que se presentan en el área de la salud pública para su abordaje. Para esto se llevó a cabo un trabajo de revisión bibliográfica en bases de datos digitales a partir de palabras clave. Se realizó una búsqueda bibliográfica utilizando las bases de dato de MEDLINE (PubMed), SCOPUS, LILACS y Google Scholar. Se incluyeron textos tanto en inglés como en español. Resultados: Se describen en el trabajo a distintas definiciones que toma la PC desde el siglo XIX hasta su actual definición internacional consensuada en 2005. Pasaron más de 150 años para establecerse una definición demostrando la complejidad que conlleva. Los aportes de la Clasificación Internacional de Funcionalidad y Salud (CIF) traen aparejados en la actualidad nuevos desafíos en el tratamiento.Conclusiones: Conocer la historia de la definición de la PC relacionándola con los cambios de paradigma de la discapacidad permite analizar la complejidad de la situación, y llama a la reflexión sobre nuestras prácticas de sanitarias. Conclusiones: Conocer la historia de la definición de la PC relacionándola con los cambios de paradigma de la discapacidad permite analizar la complejidad de la situación, y llama a la reflexión sobre nuestras prácticas de sanitarias.

Definition and classification of cerebral palsy: a historical perspective.

The definition of a diagnosis identifies explicitly which cases are to be recorded under that term and, by implication, which are to be specifically excluded. The definition is the basis for planning treatment and for counting cases in a population. Classification within a diagnosis categorizes those cases with similar characteristics together and distinguishes those cases with diverse features apart. The design of a classification system, for instance whether it is organized into nominal or ordinal categories, will vary depending on the concept being classified and intended purpose for which classification is being made. The most frequently cited definition of cerebral palsy was published by Bax (1964) as 'a disorder of posture and movement due to a defect or lesion in the immature brain'. The label does however encompass a variety of syndromes and some, therefore, prefer the term cerebral palsies.

Historical perspectives on the etiology of cerebral palsy.

This essay presents the early history on the evolution of concepts about the etiology of cerebral palsy, especially the contributions of the early pioneers. Insight into how they derived their hypotheses, including the errors they made, can help one understand the complex processes of deciphering etiologic associations.

Third ventriculostomy for internal hydrocephalus complicated by unrecognized subdural hygroma and hematoma: a case report of a patient treated by Dr. Walter Dandy.

The authors review the case of a patient treated by Dr. Walter Dandy. When the patient was a young child he underwent two right transtemporal third ventriculostomies during which he sustained an unrecognized contralateral subdural hygroma and a chronic subdural hematoma with a mild infantile hemiparesis. He was able to complete high school, albeit at a slower pace than usual. As an adult he held several limited employment positions, lived at home for several decades, and was later cared for at a nursing home for a short time. The patient died when he was 66 years of age.

Triple osteotomy of the innominate bone. 1973.

In forty-five patients, twenty-three with congenital dislocations and the rest with paralytic or other disturbances, this new displacement osteotomy of the hip joint was done when other iliac osteotomies were considered ineffective. The patients, seven to seventeen years old, were followed two to ten years. Of the fifty-two procedures, forty were satisfactory. Most of the unsatisfactory results were in cases of myelodysplasia, peroneal atrophy, and cerebral palsy.

The cerebral palsy patient.

CP is not a disease but rather a descriptive term that identifies a heterogeneous group of children who manifest primarily chronic motor impairment. It should be appreciated that the large group of children identified under this heading have a broad range of associated handicaps. It is also important to recognize that there is an extremely wide range of variability in terms of the degree of impairment each child may exhibit. Therefore, appropriate management strategies and family counseling must be individualized. The importance of communicating with families cannot be overstressed. The management of children will require expertise in many fields. A multidisciplinary approach is therefore preferable for the comprehensive management of children with CP. If a specialized multidisciplinary clinic setting is not available, an "integrated effort coordinator," the primary physician, is essential to optimize care of the child with CP.