Physicians at the Shriners Hospitals for Children, Montreal have been performing surgeries on cerebral palsy patients intended to relieve some of the spasticity associated with the condition. The doctors are hoping to spread the word about the procedure to those who need it most.
Cerebral Palsy
Cerebral palsy (CP) is the most common physical disability in children, affecting about one out of every 400 individuals in Canada. CP is generally caused by an injury to the developing brain, usually during pregnancy or a birth injury, and can manifest before, during, or after birth.
Among other things, CP can cause spasticity, resulting in muscle stiffness and making it difficult for children affected by CP to move their limbs in isolation, including to do things such as walk. These children may often require assistive devices such as wheelchairs or braces. Studies have shown that gross motor development in young people with spastic CP can plateau during their childhood and may even decline during adolescence. It is important to improve motor functioning early in such children and to actively maintain any improvements made in muscle function over time.
Some Facts About the Procedure
The surgery is called selective dorsal rhizotomy, or SDR, and is intended to alleviate some of the symptoms associated with spasticity resulting from CP. Dr. Jean-Pierre Farmer, chief of neurosurgery at Montreal’s Children’s Hospital, is one of the few doctors in Canada able to perform this procedure.
The procedure is performed on the lower spinal cord. The nerves are exposed, separated, then identified via electrical stimulation. Once they are identified, the sensory nerve fibers that cause muscle tightness are cut using electrical pulses. Nerves that properly control movement are left intact. If the surgery goes well, and all affected fibres are cut, it is possible for children with CP to have permanent reduction of muscle spasticity caused by cerebral palsy, leading to increased function.
Risks
There are a number of risks associated with the procedure, including paralysis of the legs, paralysis of the bladder, sensory loss and impotence. There are also risks associated with any surgical procedure, as well as the risk of infections. As this is a neurosurgical procedure, there is also a risk of meningitis, but the risk can be controlled with antibiotics. There is a potential for additional surgery if spinal fluid leaks from the wound.
Criteria for the Procedure
To ensure best results, the SDR Program in Montreal has strict criteria:
- The procedure is not performed on children under the age of 3 until all of the symptoms of CP have had a chance to develop. The surgery is usually not done on children older than 10 years old;
- Due to the considerable post-operative rehabilitation, candidates are usually able to follow instructions;
- The best candidates are typically children with spastic diplegia primarily in their legs;
- Children who are severe spastic quadriparetic or quadriplegic may also gain benefit due to increased physical comfort, however SDR has a lower success rate and an increased risk of the spasticity reoccurring.
- A multidisciplinary team including a neurologist, neurosurgeon, nurse, speech therapist, occupational therapist, and physiotherapist evaluates any emerging motor functions;
- The surgery is followed by a six-week recovery period at the Shriners Hospitals for Children, during which the child will undergo physiotherapy to learn how to control their legs and how to walk;
- The family of the child is provided with ongoing therapy in their home community and continue to get regular follow-up care at Shriners Hospitals for Children until the child is 18 years old.
Canadian Patients Treated So Far
A five-year-old Toronto child recently travelled to Montreal for an assessment. She was found to be a good candidate for the SDR and the Ontario Ministry of Health and Long-term Care (MOHLTC)agreed to cover the costs. The surgery was deemed to have gone well, and while the child has several months of intensive physiotherapy ahead of her, her mother told CTV News that they are already seeing progress. The child has more mobility and can now ride a modified bike.
At Sommers, Roth & Elmaleh, our goal is to obtain compensation and financial security for children and families who have been affected by cerebral palsy. As one of the oldest medical malpractice firms in Toronto, we are well-established and highly respected in the medical malpractice field and have won some of the largest medical malpractice awards in Canadian history for our clients. We regularly help clients from across Canada, including Ontario, Alberta, British Columbia, Saskatchewan, Quebec, and Newfoundland. Call us at 1-844-777-7372 or contact us online for a free consultation