Neurosurgical Management of Hypertonia in Children

Disabling hypertonia—spasticity, dystonia, or a combination—is a major clinical problem in children and is most commonly seen in cerebral palsy. This article reviews current definitions of various types of hypertonia and the management of hypertonia in these children. The multidisciplinary nature of the management is stressed, and the various modalities of treatment are discussed, with an emphasis on the neurosurgical aspects of management. The two major neurosurgical treatments, namely, selective dorsal rhizotomy and intrathecal baclofen, are reviewed in detail, with the current knowledge about outcomes with these treatments presented according to a paradigm developed by the National Council for Medical Rehabilitation Research. Guidelines are provided for the selection of the most appropriate treatment modalities in any given situation.