Neurosurgery for Spasticity

The book, in its second edition, is devoted to the neurosurgical management of spasticity and focal dystonia. Starting with a chapter on the anatomical and physiological bases of spasticity and a short history of its neurosurgical treatment, it describes the neurosurgical methods currently available. As management differs between adults and children, the book is also structured accordingly, including evaluation, decision-making, Intrathecal Baclofen therapy (ITB), Botulinum toxin therapy and Surgery. The large spectrum of scales for assessing hypertonia, spasticity, dystonia, contracture and joint/bone deformities, as well as the scoring systems for quantifying functional abilities are critically reviewed. Beyond ITB, the neurosurgical options covered include the microsurgical procedures focusing on the peripheral nerves, dorsal roots, Dorsal Root Entry Zone and spinal cord, and their intra-operative monitoring.

In this second edition, the orthopedic surgical interventions available will take a large place, either as alternative solutions , or even better as important complements after spasticity be solved by the neurosurgical treatments.

Based on surgical experience collected with more than a thousand and eight-hundred patients, the book gathers the most important aspects of our present understanding, presented using a practical, educational approach. It stresses the importance of a multidisciplinary approach, including neurologists, pediatricians and rehabilitation specialists. Close collaborations with other surgical disciplines like orthopedic surgery and neuro-urology are outlined.

Chapter 1) Introduction. - Chapter 2) History of Neurosurgical Treatment for Spasticity. - Chapter 3) Anatomical Bases of Tone and Spasticity. - Chapter 4) Assessment of Spasticity in Adults. - Chapter 5) Decision-Making for Adults with Disabling Spasticity. - Chapter 6) Intrathecal Baclofen Therapy. - Chapter 7) Botulinum Toxin Injections for Spasticity. - Chapter 8) Peripheral Neurotomy. - Chapter 9) Surgery in the Dorsal Root Entry Zone. - Chapter 10) Spasticity and Hypertonia in Cerebral Palsy: Mechanisms and Surgical Implications. - Chapter 11) Assessment of Spasticity in Pediatric Patients. - Chapter 12) Decision-Making for Neurosurgical Treatment in Children with Disabling Spasticity. - Chapter 13) Dorsal Rhizotomy for Children with Cerebral Palsy. - Chapter 14) Neuro-Orthopedic Surgery for Correction of Spastic Disorders. - Chapter 15) Management of Neurogenic Overactive Bladder. - Chapter 16) Brief on Decision-Making for Neurosurgery of Spasticity in Adults and Children. - Chapter 17) Scales and Forms to Be Used in Practice.