- Neurosurgical Treatment for Cerebral Palsy Spasticity
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Seong-Ho Kim, Byung-Yon Choi
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Yeungnam Univ J Med. 2007;24(2 Suppl):S186-191. Published online December 31, 2007
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DOI: https://doi.org/10.12701/yujm.2007.24.2S.S186
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 Abstract
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- The spasticity of cerebral palsy is usually a useful substitute for deficiency of motor strength. However not infrequently, it may become harmful leading to an aggravation of motor disability. When excessive spasticity is not sufficiently controlled by physical therapy and pharmacological treatment, patients can have recourse to neurosurgery: neurostimulation, intrathecal baclofen or selective ablative procedures. Because excessive hypertonia has to be reduced without suppression of the useful muscular tone or impairment in the residual motor and sensory functions, neuroablative procedures must be as selective as possible. These selective lesions can be performed at the level of peripheral nerves, spinal roots, or the dorsal root entry zone(DREZotomy). The new neurological status brought about by the neurosurgical operation will reach its optimal level only if intensive, prolonged, comprehensive treatment is provided by an expert multidisciplinary team including rehabilitation medicine. The neurosurgical treatment must take place before the onset of irreversible articular disturbances and musculotendinous retractions, which require complementary orthopedic corrections.
- Nondestructive Neuroaugmentative Surgery for Intractable Cancer Pain
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Seong-Ho Kim, Byung-Yon Choi, Soo-Ho Cho
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Yeungnam Univ J Med. 2007;24(2 Suppl):S192-202. Published online December 31, 2007
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DOI: https://doi.org/10.12701/yujm.2007.24.2S.S192
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Abstract
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- Pain is probably one of the most common cancer symptoms. In addition to being a major source of suffering and disability, cancer pain is extremely frightening for patients and their families. The authors propose to adjust the World Health Organization (WHO) pain management ladder from its current three-step approach to a more sophisticated five-step algorithm that includes physical and psychological modalities along the entire continuum of care and adds two more steps related to neuromodulative and neurodestructive procedures once the opioids fail. This review discusses the current surgical options for treating cancer pain, focusing on the continuous drug infusion pump currently available and briefly exploring some of the other surgical options for pain management. The introduction of intrathecal opioid administration for intractable cancer pain is considered as one of the most important breakthroughs in pain management. Morphine, the only opioid approved by FDA for intrathecal administration, has been increasingly utilized for this purpose.
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Yeungnam University College of Medicine
