ניתוחים נוירוכירורגיים (משאבת בקלופן וריזוטומיה סלקטיבית דורזלית): ההשפעה על כאב הקשור בספסטיות ועל איכות החיים
NEUROSURGICAL INTERVENTION FOR SEVERE SPASTICITY (ITB & SDR): IMPACT ON SPASTICITY RELATED PAIN AND ON QUALITY OF LIFE
Liana Beni-Adani*, Ron Lamdan**, Yael Harel*, Nava Gelkopp***, Aviva Fatal*, Liora Sagie*, and Hila Ben-Pazi***
Dana Children's Hospital*, TASMC, Tel-Aviv, Hadassah Hospital and Hebrew University**, and Sharee Zedek Hospital***, Jerusalem
Patients who are considered for a neurosurgical procedure to reduce spasticity (ITB Pump/SDR) may be divided to 2 Main Groups: a. Severely impaired individuals, “Low Function” (GMFCS V), in whom the goals of surgery would be to provide comfort, improve positioning and ease of care; b. "High Function" individuals, in whom the goals of treatment would be improving function. Patients from both groups may suffer from spasticity related pain; therefore decrease in pain would be an important step to improve quality of life.
Patients and methods:
In a prospective series of spastic patients with GMFCS 2-5, 9 patients underwent Selective Dorsal Rhyzotomy (SDR) and 40 ITB pump implantation for severe spasticity. We looked at different clinical parameters including pain and discomfort before and after neurosurgical intervention.
Pain/discomfort either during active/passive movements, or at rest (related to spasms) were important complaints (of patients or caregivers) in 83% patients (41/49). In 43% pain and discomfort were the major complaint.
In 37 patients (90%) there was significant improvement in pain and patients or caregivers reported facilitation of transfers, handling or physiotherapy due to decrease in pain during these activities.
Decrease in pain was an achievable goal in most of the "low function" patients facilitating improved sitting, handling and transfers. In high function patients decrease in spasms or spasticity related pain enabled more intensive physiotherapy and exercise to maintain range of motion. This parameter in itself affected positively the quality of life in 90% of operated patients.