Columbia Neurosurgery » spasticity

Our Pediatric Neurosurgeons Present at Pool Symposium

Department Author — Fri, 09 Dec 2011 22:38:54 +0000

Dr. Neil Feldstein

The annual Pool Symposium was held once again here at Columbia and the theme this year was pediatric neurosurgery.

Dr. Neil A. Feldstein, Dr. Richard Anderson, and Dr. Saadi Ghatan from the Pediatric Neurosurgery Center were all there and each presented in their areas of expertise.

Dr. Feldstein spoke about chiari malformations* and craniosynostosis** surgery. He can be seen in the top left photo discussing normal skull anatomy.

Dr. Richard Anderson

Dr Anderson presented Spinal Dysraphism and Neurosurgical Management of Childhood Spasticity. He can be seen at right elucidating spasticity treatment options.

Dr. Ghatan discussed hydrocephalus*** and epilepsy**** management. He can be seen in the bottom left photo relaying the history of epilepsy surgery.

Dr. Saadi Ghatan

Dr. Feldstein tells us, “We also had guest speakers who discussed pain management and Emergency Room management of our patients.”

Once again, the event was a great success!

**You can learn more about craniosynostosis from our blog, The Importance Of Baby’s ‘Soft Spot’.

***Read the story about Sherman Alexie: Born With Hydrocephalus, Now A Well Known Author.

****Read this story, All He Wanted Was To Drive: An Epilepsy Success Story

Anderson’s Spasticity Program has Grown by Leaps and Bounds

Department Author — Fri, 13 May 2011 06:56:15 +0000

Dr. Richard Anderson Director, Spasticity Center

In 2005, Dr. Richard Anderson from the Pediatric Neurosurgery Center started the Spasticity Center here at Columbia. The program has grown by leaps and bounds and that is exactly what he aimed for–quite literally.

According to Dr. Anderson, when the Spasticity Center opened six years ago, they had just four patients. That number has steadily grown over the years and they now regularly follow nearly 300 patients.

The Spasticity Center at NewYork-Presbyterian Morgan Stanley Children’s Hospital is a multidisciplinary program that includes pediatric specialists in neurosurgery, neurology, orthopedic surgery, physical medicine and rehab (physiatry), physical and occupational therapy, nursing, social work, and orthotics. Spasticity results from damage to the motor pathways of the brain or spinal cord. It is characterized by stiff muscles and exaggerated reflexes that can interfere with gait, movement, or speech.– New York Presbyterian Spasticity Center

Spasticity has the effect of almost trapping a child in their own body. Muscles become so tightly held that normal tasks like walking and running can become nearly impossible. When spasticity is treated effectively the result is more relaxed muscles and a child who can run and play like never before.

The multidisciplinary team allows a myriad of treatment strategies to be developed that are tailored for every patient. These include physical and occupational therapies, oral medications, intramuscular injections (botox, phenol, and alcohol), orthopedic surgeries, and neurological surgeries (rhizotomy and intrathecal baclofen pump). One of the most effective ways spasticity can be reduced permanently is with a highly specialized surgery called a minimally invasive selective dorsal rhizotomy.

Normally an all-day and highly invasive surgery with multiple levels of bone removal, Dr. Anderson and his team are able to perform the surgery in much less time using minimally invasive techniques and removal of only one level of bone through a 1.5 inch incision.

This means a quicker, less painful recovery, and children who can sooner get down to the important business of leaping and bounding.

Congratulations Dr. Anderson and the team at the Spasticity Center on your tremendous success!

Spasticity

Brigitte Matsuoka — Thu, 06 Aug 2009 03:12:31 +0000

Spasticity is a neuromuscular condition in which muscles are continuously contracted. The stiff or rigid muscles inhibit normal activity, including walking, movement, and speech. Spasticity in children has numerous potential causes, most of which include some form of damage to the nervous system, such as brain damage caused by a lack of oxygen, brain trauma, stroke, or spinal cord injury. Certain metabolic disorders also may cause spasticity. When nervous system damage takes place before birth, the resulting nerve and muscle problems, including spasticity and loss of muscle control, are known as cerebral palsy. The neural damage that causes spasticity typically takes place in the cerebral cortex, the region of the brain that controls movement, or the nerves that travel from the brain to the spinal cord.

Symptoms

Spasticity can take many forms, including the inability to bend limbs because of overactive deep tendon reflexes, joints that stay bent at unusual angles, crossing of the arms or legs (called scissoring), repetitive jerky movements (called clonus), abnormal posture, and speech problems. These problems also vary in severity, from mild muscle stiffness and increased muscle tone to painful, uncontrollable, and debilitating muscle spasms. Long-term spasticity can result in permanent contracture of muscles, in which muscles shrink and lock joints in a single position.

Diagnosis

Complete physical examination and neurological testing are necessary to assess the extent of spasticity. Physical & occupational therapists also will examine the child to determine exactly which muscles are involved.

Treatment

There are several forms of treatment for spasticity. Physical & occupational therapy is an important treatment that likely will be required regardless of other treatment choices. This involves a daily regimen, which parents can do at home with their children, of joint movement, exercise, and stretching that alleviates the severity of the symptoms. Therapy also may include fixing a joint with a cast or brace to oppose the spastic muscle.

In addition, a range of medications, including baclofen, tizanidine, benzodiazepines, and dantrolene sodium, may be used. These medications are taken orally, but in severe chronic cases, a pump that administers baclofen directly to the fluid that surrounds the spinal cord may be surgically implanted. Another form of treatment commonly used is called chemodenervation and involves the injection of botulinum toxin type A to loosen the spastic region.

Surgery for severe chronic spasticity includes orthopedic and neurological approaches. Orthopedic surgeries may involve altering tendon, muscle, and bone to restore movement and flexibility. These approaches may be done in children to maintain function as a child grows. Neurological surgeons employ another type of procedure called selective dorsal rhizotomy, in which the nerves that carry sensory information to the spastic limbs are cut where they emerge from the spinal cord. These nerves play a key role in the generation of spasticity. The procedure often is used in children with cerebral palsy and has been shown to improve leg function. The decision to treat spasticity surgically depends on the extent and severity of the condition and the child’s other medical concerns. Often only one part of the body will be treated surgically because it will make specific movements necessary for daily living easier.

Pediatric Neurosurgery Center

Brigitte Matsuoka — Mon, 03 Aug 2009 22:30:34 +0000

The Pediatric Neurosurgery Center specializes in the evaluation and treatment of children with a range of neurosurgical disorders, such as brain tumors, spasticity, movement disorders, intractable epilepsy, hydrocephalus, craniosynostosis, head injuries, and spina bifida, as well as other cranial malformations and spinal deformities. Our surgeons work as part of a multidisciplinary team of pediatric practitioners, offering a range of specialized expertise that can only be found at a hospital dedicated solely to children.

The Pediatric Neurosurgery Center is internationally recognized for its outstanding care of infants, children, and young adults with diseases or injuries to the brain or spinal cord. Members of our team are actively involved in clinical research on pediatric brain tumors, supported by the Pediatric Brain Tumor Fund. Studies consistently demonstrate that experienced surgeons at neuroscience centers of excellence achieve the best possible patient outcomes.

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