Neurosurgery for Spasticity: A Multidisciplinary Approach

Considerable advances have been made in the treatment of medically uncontrollable spasticity through functional neurosurgery over the past two decades. Therefore the editors have asked a number of renowned experts to present the current state of knowledge in the field. Neuroanatomical, physiological and chemical mechanisms of tone are first outlined, then the main clinical and neurophysiological methods of assessing and quantifying spasticity are discussed. This is followed by the basic principles of pharmacologic treatment. Methods involving neurostimulation of the spinal cord, cerebellum and brain, are critically reviewed. There is an extensive discussion of the bases and techniques of pharmacologic treatment using intrathecal ‘baclofen’ administered by an implanted pump. The classical neuroblative procedures and their recent modifications using microsurgical techniques and intraoperative neural stimulation are described. Short complementary practical chapters are devoted to the spastic bladder and its treatment, and to orthopedic procedures for correcting the consequences for spasticity. Finally, guidelines are given for treatment for adults and children functionally debilitated by their spasticity. This book is designed to be of use not only to neurosurgeons, but to all specialists involved in the management of spasticity.