| Surgical Treatment of Poststroke Hemiplegic Spasticity |
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Seong-Ho Kim |
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Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Korea |
| 뇌졸중 후 편마비성 경직의 수술 |
|
김 성 호 |
|
영남대학교 의과대학 신경외과학교실 |
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| Abstract |
Objective
Spasticity is a movement disorder that develops gradually in response to a partial- or complete loss
of supraspinal control of spinal cord function. It is characterized by altered, activity patterns of motor units occurring
in response to sensory and central command signals which lead to co-contractions, mass movements and abnormal
postural control. Although spasticity in adults may result from a variety of central nervous system diseases, a
hemispheric lesion in an adult, following a stroke or trauma, can result in spasticity developing over a varying
interval. Because it is frequently associated with, or masked by symptoms such as dystonia, dyskinesia, motor
weakness or sensory disturbances, functional evaluation requires a multidisciplinary approach.
Materials
and Methods: Surgery should only be considered after the individual has been closely examined for
signs of conditions which would aggravate his or her spasticity. There must also be a review of the individual's
current therapy and medications to ensure that there has been an adequate trial with these agents. Whatever
surgical procedure is selected, its goal should be to diminish the excessive hypertonia without suppressing useful
muscle tone or limb function.
Results
Neuroablative techniques are indicated for severe spasticity which is localized to the limbs of hemiplegic
patients. Motor point and nerve blocks, as well as precutaneous thermal rhizotomies or intrathecal chemical rhizotomies
offer reduction in spastic tone on a temporary basis. The open, destructive procedures which seek to produce a permanent
alleviation of the spasticity must be selective and target abnormal circuits while preserving those necessary for the more
normal sensory and motor functions. When spasticity is localized to muscles or muscle groups innervated by a small
number of or single peripheral nerve, peripheral neurotomy may be used. For the patients with severe spasticity affecting
entire limb, there are several procedures to choose from: dorsal rhizotomies, longitudinal myelotomy, and microsurgical
drezotomy (MDT).
Conclusion
Personally, MDT is preferred because it not only selectively interrupts the afferent myotactic and flexor
reflex fibers but also acts on the gating mechanisms within the spinal cord by shifting the modulatory activity towards
pain inhibition. Presently, there is a tendency to combine several types of neuroablative procedures in one patient. |
| Key Words:
Hemiplegic spasticityㆍMovement disorderㆍNeuroablative technique |
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