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Objective: We studied physicians' opinions and experiences concerning clinical concerns, perceived severity, occurrence, and management of baclofen withdrawal due to abrupt discontinuation.Methods: A nationwide 26-question electronic survey was distributed via e-mail to physicians (N = 952) representing varying specialties who manage spasticity with baclofen. A total of 110 physicians provided responses to the survey (response rate = 11.6%). Results were evaluated using descriptive statistics.Results: Withdrawal from both oral and intrathecal (IT) baclofen was recognized as a significant concern and was observed by most respondents. However, approximately 75% and 35% of respondents or their clinic sites lack established management protocols for managing anticipated interruption of oral or IT baclofen, respectively.Conclusions: These findings highlight the need for further research on and the development of guidelines for the prevention and treatment of baclofen withdrawal. The results of this survey, along with a systematic literature review and multidisciplinary stakeholder input, may be helpful in establishing guidelines for the treatment and prevention of baclofen withdrawal. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to determine the feasibility and efficacy of five treatments of 6 Hz primed, low-frequency, repetitive transcranial magnetic stimulation (r TMS) combined with constraint-induced movement therapy ( CIMT) to promote recovery of the paretic hand in children with congenital hemiparesis. Method Nineteen children with congenital hemiparesis aged between 8 and 17 years (10 males, nine females; mean age 10 years 10 months, SD 2 years 10 months; Manual Ability Classification Scale levels I- III) underwent five sessions of either real r TMS ( n=10) or sham r TMS ( n=9) alternated daily with CIMT. CIMT consisted of 13 days of continuous long-arm casting with five skin-check sessions. Each child received a total of 10 hours of one-to-one therapy. The primary outcome measure was the Assisting Hand Assessment ( AHA) and the secondary outcome variables were the Canadian Occupational Performance Measure ( COPM) and stereognosis. A Wilcoxon signed-rank sum test was used to analyze differences between pre- and post-test scores within the groups. Analysis of covariance was used to compute mean differences between groups adjusting for baseline. Fisher's exact test was used to compare individual change in AHA raw scores with the smallest detectable difference ( SDD) of 4 points. Results All participants receiving treatment finished the study. Improvement in AHA differed significantly between groups ( p=0.007). No significant differences in the secondary outcome measures were found. Eight out of 10 participants in the r TMS/ CIMT group showed improvement greater than the SDD, but only two out of nine in the sham r TMS/ CIMT group showed such improvement ( p=0.023). No serious adverse events occurred. Interpretation Primed, low-frequency r TMS combined with CIMT appears to be safe, feasible, and efficacious in pediatric hemiparesis. Larger clinical trials are now indicated. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to review the effect of rimabotulinum toxin (BoNT-B) for focal hypertonicity management in children with cerebral palsy and secondary nonresponse to onabotulinum toxin treated at the authors' tertiary care academic medical center. Design: A retrospective review of the medical treatment of children was conducted at the authors' institution (March 1 6, 2001, to August 2, 2002) using the keywords botulinum toxin Band Myobloc (Solstice Neurosciences Inc, South San Francisco, CA). Demographic information was analyzed using descriptive statistics (number [percentage] and mean [range]). The Pearson x2 test was used to evaluate differences in incidence of adverse events. Results: Eighty-two children had BoNT-B injections (116 treatments). Overall, 26.8% (19/71 ) of the children or their parents/guardians reported no or minimal response to the injections, with 89.5% (17/19) of these children having secondary nonresponse to onabotulinum toxin. Adverse events were frequent but did not require hospitalization of any patient. No significant differences were found in incidence of adverse events related to BoNT-B dosing, medical fragility, or Gross Motor Function Classification System level. Conclusions: More than one-fourth of the children receiving BoNT-B injections had nonresponse, with most having previous nonresponse to onabotulinum toxin. Adverse events related to BoNT-B injections were frequent and unpredictable but not severe. [ABSTRACT FROM AUTHOR]

Aim To determine whether intrathecal baclofen (ITB) changes mortality risk in persons with cerebral palsy (CP). Method Records were reviewed for all persons with CP who were managed with ITB for hypertonicity at a specialty hospital in Minnesota between May 1993 and August 2007. A comparison cohort was randomly selected from clients of the California Department of Developmental Services who were initially evaluated between 1987 and 1990 and were matched to those with ITB for age, sex, Gross Motor Function Classification System (GMFCS) level, presence or absence of epilepsy, and feeding-tube use. Survival probabilities were estimated using the Kaplan–Meier method, and differences were tested via log-rank. Results Three hundred and fifty-nine persons with CP (202 males, 157 females) receiving ITB for hypertonicity (mean age 12y 8mo, SD 7y 9mo, range 3y 1mo to 39y 9mo) were matched to 349 persons without ITB pumps (195 males, 154 females; mean age 12y 7mo, SD 8y 4mo, range 2y 7mo to 40y). The proportion of patients at different GMFCS levels in the ITB and in the non-ITB cohorts, respectively, was as follows: level II 3% and 3%, level III 16% and 16%, level IV 38% and 37%, and level V 43% and 44%. Survival at 8 years of follow-up was 92% (SD 1.9%) in the ITB cohort and 82% (SD 2.4%) in the non-ITB cohort ( p<0.001). After adjustment to account for recent trends in improved survival in CP, 8-year survival in the non-ITB cohort was 88%, which was not significantly different from the ITB cohort ( p=0.073). Interpretation ITB therapy does not increase mortality in individuals with CP and may suggest an increase in life expectancy. [ABSTRACT FROM AUTHOR]

Intrathecal baclofen (ITB) is an effective treatment for both spasticity and dystonia in people with cerebral palsy (CP). Its use is becoming increasingly common. ITB is typically associated with fewer side effects than the oral form of the product, but there are risks related to the hardware needed for intrathecal delivery. Much of what has been reported in the literature about ITB is based on experience with children or groups of children and adults; few reports exclusively address its use in adults with CP. These reports indicate that muscle tone is consistently reduced, but there is some variability in functional outcomes. Few well-controlled studies have been done. Controversies remain concerning ITB, including whether a trial is needed before pump implantation, proper catheter tip placement, and programming options, as well as whether it contributes to the development or progression of scoliosis. These and other unanswered questions should be addressed in a systematic way. [ABSTRACT FROM AUTHOR]

The objective of the present study was to understand the clinical reasons for changes from simple continuous to complex (flex) dosing for tone reduction in individuals receiving intrathecal baclofen. Methodology was a retrospective chart review study of 164 individuals (95 male, 69 female) at a multi-specialty children’s hospital who were followed for at least 1 year for intrathecal baclofen management. Eighty-two persons were in the simple continuous only group and 82 also were on complex schedules at least once during the follow-up period. Mean age at most recent follow-up was 18 years and 0 months (median, 15 years and 8 months; standard deviation, 8 years and 0 months; range, 6-45). The top three clinical reasons for switching dosing method were to (1) optimize intrathecal baclofen effect, (2) treat predictable daily tone variation, and (3) manage signs and symptoms of intrathecal baclofen withdrawal or underdelivery. In both groups, 90% of individuals had cerebral palsy, and mean baseline leg Ashworth scores were the same in both groups (mean, 3.7; standard deviation, 0.7). Mean total daily dose at chart review was higher in complex dosing (429.3 vs 211.9 μg/day), as was mean follow-up time (4.8 vs 3.9 years). Case examples are presented. [Copyright &y& Elsevier]

The purpose of this study was to assess whether there is an improvement in motor function in persons with cerebral palsy (CP) who have had a reduction of muscle tone by continuous intrathecal baclofen infusion. This was a prospective, open label, non-blinded case series without a control group, conducted at multiple centres. There were 31 subjects, aged 4–29 years. All had a pre-treatment mean lower extremity Ashworth scores of ?=?3 and a significant reduction in tone after a bolus injection of intrathecal baclofen (ITB) and received an implanted pump for continuous delivery of ITB. Motor function was assessed by the Gross Motor Function Measure (GMFM) prior to and 1 year following pump implantation. Significant improvement ( p <0.05) in mean GMFM scores was seen in subjects <8 years (mean change 4.1) and in those from 8–18 years (mean change 3.7) and in subjects with CP Classes 2 and 5 (mean changes 6.2 and 2.9). There was a statistically significant decrease ( p <0.05) in Ashworth scores in CP classes 2–5. Subjects or their caregivers that completed a survey about perceived changes stated that motor control, positioning and endurance improved. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess whether reduction of muscle tone by continuous intrathecal baclofen infusion affects the progression of hip subluxation in persons with cerebral palsy. This prospective, open-label, case series was conducted at multiple specialty referral centers. There were 33 subjects, ages 4 to 31 years. All had a pretreatment lower extremity Ashworth score of ≥3; all subjects had a significant reduction in tone after a bolus injection of intrathecal baclofen and received an implanted pump for continuous delivery of intrathecal baclofen. Subjects had hip x-rays before and 1 year after pump implantation. The primary outcome measure was change in absolute hip migration percentage. One third of the hips had an increase of absolute migration percentage of 5% or more; 12% of the hips had a decrease of migration percentage of 5% or more. Change of migration percentage class was used as a second outcome criterion. 90.9% of hips manifested no deterioration or had improvement of their migration percentage class during the year of intrathecal baclofen therapy. The observed changes were not associated with the subject''s age or the severity of cerebral palsy. [Copyright &y& Elsevier]

Spasticity is a common problem in children with neurologic impairment, particularly in those with cerebral palsy. Clinicians commonly make use of oral medications to attempt to reduce spasticity and increase function. Little has been published in the literature concerning the use of these medications in children and their effects on both muscle tone and function. This article is a review of the sites of action, side effects, and efficacy of benzodiazepines, baclofen, dantrolene sodium, alpha[sub 2]-adrenergic agonists, and gabapentin. A brief review of intrathecal baclofen is included as well. (J Child Neurol 2001;16:31–36). [ABSTRACT FROM AUTHOR]

OBJECTIVE: Idiopathic toe-walking (ITW) is a diagnosis of exclusion. A relationship between ITW and decreased range of motion (ROM) is postulated. Treatments focus on increasing ankle dorsiflexion including serial casting. There is no consensus for duration of serial casting. This study aimed to determine ROM changes with cast change intervals of one vs. two weeks, and the rate of ITW recurrence. METHODS: This was a retrospective study of 86 patients, ages 0–9 years with ITW undergoing weekly casting (N = 29) and two-week casting (N = 57) at a children's hospital from 2014–2020. ROM at baseline, two weeks, four weeks, and final cast removal were collected. Statistical analyses included chi-squared tests, two-sample t-tests, and linear mixed regression. Outcome distributions were assessed for normality. P-values < 0.05 were considered statistically significant. RESULTS: After adjusting for baseline ROM, the mean change in ROM from baseline to two weeks was 10.6∘ vs 7.5∘ in the one-week vs. two-week casting interval, respectively (p < 0.001). The baseline to final measurement was 13.4∘ vs 9.8∘ in the one-week vs. two-week casting interval, respectively (p < 0.001). The rate of recurrence of ITW was similar between the two groups. CONCLUSION: This study suggests greater improvement in ROM in the one-week vs. two-week casting interval group. [ABSTRACT FROM AUTHOR]

Aim: To examine long-term outcomes of selective dorsal rhizotomy (SDR) 10 to 17 years after surgery.Method: Participants who underwent SDR had spastic diplegic cerebral palsy (CP), completed baseline gait analysis, and were 16 to 25 years old at follow-up. Non-SDR participants (i.e. controls) were matched on important clinical parameters at baseline but did not undergo SDR. All study participants completed six surveys assessing pain, quality of life, participation, function, and mobility. Treatment history for lower extremity surgery and antispasticity injections was tabulated. A subset of each study group returned for three-dimensional gait analysis, including kinematics, metabolic energy cost, and physical examination. Gait Deviation Index (GDI) was calculated to measure gait quality.Results: The study cohort had 24 participants with SDR and 11 without SDR. Of these, 13 patients with SDR (five males, eight females; median [IQR] age 17y 2mo [16y 8mo-17y 9mo]) and eight without SDR (three males, five females; median [IQR] age 19y 2mo [17y 3mo-21y 11mo]) completed baseline and follow-up gait analysis. Spasticity significantly decreased in those with SDR (p<0.05). Gait Deviation Index improved more in participants without SDR than those with SDR (Δnon-SDR =12.8 vs ΔSDR =9.1; p=0.01). Compared with the SDR group, participants without SDR underwent significantly more subsequent interventions (p<0.05).Interpretation: Patients in both the SDR and non-SDR groups showed improved gait quality more than 10 years after surgery. Participants without SDR had a larger improvement in gait pathology but underwent significantly more intervention. There were no differences between groups in survey measures. These results suggest differing treatment courses provide similar outcomes into early adulthood.What This Paper Adds: Selective dorsal rhizotomy (SDR) and non-SDR groups had significant improvement in gait pathology over time. The non-SDR group had significantly better gait compared with the SDR group at follow-up. The groups had similar levels of energy cost, pain, and quality of life. Non-SDR participants underwent significantly more orthopaedic surgery and antispasticity injections than SDR participants. Use of a clinically similar control group highlights that different treatment courses may result in similar outcomes into young adulthood. [ABSTRACT FROM AUTHOR]

Objectives: The goals of this study were (1) to describe changes in functional status of pediatric patients with encephalitis from admission to discharge at an acute rehabilitation facility and (2) to identify the presence of persistent impairments on long term follow-up. Design: Retrospective chart review of 25 children admitted to one pediatric acute rehabilitation unit with a diagnosis of encephalitis from 2000-2013. Five patients were excluded due to a previous history of neurodevelopmental disabilities and two were excluded due to missing data. Data collected included demographic information, WeeFIM scores at admission and discharge, and impairments documented at the most recent follow-up visit. A 1 tailed paired t-test of WeeFIM scores and descriptive statistics for follow-up data were performed. Results: Average inpatient length of stay was 7.3 weeks. Statistically significant improvements were seen in WeeFIM scores in self-care, mobility, and cognition from admission to discharge (p <0.01 for each domain). Average follow-up length was 3 years. One child did not have follow-up data. On followup, 9/17 children had mobility impairments, 8/17 had cognitive impairments, and 11/17 had psychological impairments. All but one individual with mobility impairments were able to ambulate independently but had problems with movement disorders (n=6), hemiparesis (n=3), or slow gait (n=1). 7/8 patients with cognitive impairments required special education services. The most common psychological impairment was attention deficit (n=5). 9/11 patients who initially received enteral feedings were eating orally at follow-up. 11 patients continued to receive at least one type of outpatient therapy. Conclusions: This chart review showed that children with encephalitis improve during their inpatient rehabilitation stay, but that many are left with at least mild impairments on follow-up. It is important to ensure adequate follow-up services are in place to give these children the best opportunity for success. [ABSTRACT FROM AUTHOR]

Hemiparetic cerebral palsy (HCP), weakness on one side of the body typically caused by perinatal stroke, is characterized by lifelong motor impairments related to alterations in the corticospinal tract (CST). CST reorganization could be a useful biomarker to guide applications of neuromodulatory interventions, such as transcranial direct current stimulation (tDCS), to improve the effectiveness of rehabilitation therapies. We evaluated an adolescent with HCP and CST reorganization who demonstrated persistent heightened CST excitability in both upper limbs following anodal contralesional tDCS. The results support further investigation of targeted tDCS as an adjuvant therapy to traditional neurorehabilitation for upper limb function. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to examine long-term outcomes of nonpharmacological intervention in children and adolescents with stroke utilizing repetitive transcranial magnetic stimulation (rTMS) to the primary motor cortex combined with constraint- induced movement therapy (CIMT) to improve motor function in the paretic hand. Outcome measures included function, satisfaction, and medical status review.Methods: Fourteen of the original 19 participants (74%) from our rTMS/CIMT clinical trial (real rTMS+CIMT, n = 8; and sham rTMS+CIMT, n = 6) were evaluated. The median age of the subjects at follow up was 13.4 years (range 11-20 years old, 50% male). Median time to follow-up was 47.5 months (range 21-57 months). Descriptive statistics were conducted using frequencies and counts. Motor performance was measured using the Assisting Hand Assessment (AHA) and Canadian Occupational Performance Measure (COPM). Satisfaction was reported with use of the COPM and TMS Tolerance Survey. Open-ended interview was conducted for feedback on study experience and subjective perspectives of current functional status.Results: Overall, seven of eight individuals who received real rTMS and five of six individuals who received sham rTMS maintained or improved AHA scores. Six of 14 participants reported new onset of co-occurring conditions (four individuals in the real rTMS group, two individuals in the sham rTMS group). The majority (86%) of participants reported study satisfaction. Review of medical status revealed co-occurring conditions including: Epilepsy, obsessive-compulsive disorder, anxiety, depression, unspecified mood disorder, and undiagnosed inattentiveness.Conclusions: Long-term outcomes of rTMS/CIMT in pediatric stroke were investigated. Variability in performance and unattributed symptoms were noted. Considering the prevalence of co-occurring conditions in children and adolescents with stroke, new-onset symptoms were not attributed to original intervention. With the small sample size, the impact of rTMS on long-term outcomes cannot be fully determined from these data. Characterizing long-term outcomes through performance, participant perspectives, and medical status allows comprehensive assessment of rTMS/CIMT intervention efficacy. [ABSTRACT FROM AUTHOR]

Objective: Assess safety and tolerance of intravenous (IV) baclofen using a dog model. Design: Prospective pharmacokinetic study involving 6 adult dogs. Two dogs received baclofen 10 mg oral and IV bolus doses. Subsequent 4 dogs were given IV boluses of 0.5, 1.0 and 1.5 mg/kg followed by constant infusion of baclofen (rates of 0.1, 0.2 and 0.4 mg/kg/hour). Also, dogs were given single IV 2 and 3 mg /kg bolus doses. Outcome measures included clinical observation scales and baclofen levels. Results: Oral bioavailability was 0.66 and 0.69 in 2 dogs. Following IV baclofen, terminal phase half-lives were 3.3 and 3.6 hours. Single bolus doses of 2 and 3 mg/kg caused mild to moderate clinical changes which were delayed at least 2 hours after peak blood levels. Boluses of 0.5 and 1.0 mg/kg with constant infusion between boluses were tolerated, however within 30 minutes of beginning constant infusion of 0.2 mg/kg/hr after the second bolus (1.0 mg/kg), dogs showed progressive sedation and ataxia. Clinical improvement occurred within 7 hours of stopping baclofen. Dogs appeared normal by the next morning. Conclusions: IV baclofen bolus doses of 0.5 to 3 mg/kg were well tolerated. Maximum clinical effect was delayed for at least 2 hours after peak plasma levels. [ABSTRACT FROM AUTHOR]

This randomized, double-blind, placebo-controlled study compared the efficacy of inhaled nitrous oxide (N2O) with enteral midazolam for sedation of children with cerebral palsy (CP) undergoing botulinum toxin A (BoNT-A) injections. Fifty children (29 males, 21 females; mean age 8y 2mo [SD 4y 5mo]; range 1–16y) were randomized to sedation with N2O ( n=25) or midazolam ( n=25). Groups were similar in type of CP (diplegia, 11; triplegia, three; quadriplegia, 16; hemiplegia, 16; other, three) and Gross Motor Function Classification System level (Level I, 4; II, 24; III, 4; IV, 13; V, 5). Both groups were equally sedated at time of injection ( p=0.661), but those in the midazolam group were more sedated at time of discharge ( p<0.001). N2O was more effective in reducing pain compared with midazolam as measured using the Face, Legs, Activity, Cry, Consolability (FLACC) scale ( p=0.010), parental estimate of pain ( p=0.009), and nursing estimate of pain ( p=0.007). Parents in the N2O group rated it better than prior sedation with midazolam for BoNT-A injections ( p=0.031). Physicians and nurses reported no difference in ease of procedure between the groups. One child in the midazolam group and eight in the N2O group had adverse effects, all of which resolved promptly. N2O appears to be an effective means of sedation for children undergoing outpatient BoNT-A injections. [ABSTRACT FROM AUTHOR]

This study retrospectively evaluated the safety and efficacy of selective dorsal rhizotomy (SDR) in participants who underwent a rigorous selection process, uniform surgical procedure, and a standardized postoperative rehabilitation process. Outcome measures assessed were the Ashworth scale for spasticity, the Gillette Gait Index (GGI) for overall gait pathology, oxygen cost for gait efficiency, and the Gillette Functional Assessment Questionnaire (functional walking ability scale; [FAQ]) for functional mobility. Outcomes were evaluated for 136 children (81 males, 55 females; mean age 7y 3mo [SD 2y 1mo], range 3y 5mo–18y 9mo) for an average of 18.3 months (SD 4.4mo) postoperatively. All participants had a diagnosis of cerebral palsy (CP): 10 quadriplegia, 19 triplegia, and 107 diplegia. Preoperative Gross Motor Function Classification System levels were: Level I n=6; Level II n=64; Level III n=59, and Level IV n=7. All outcome measures improved for the group as a whole. Spasticity improved with 66 to 92% of possible gain in Ashworth scores; GGI was 7.5 times more likely to have a good as opposed to a poor outcome; energy efficiency improved in over half of the participants, and the FAQ demonstrated a statistically significant improvement of 0.9 levels ( p<0.001). The rate of complications was low, with peri- and postoperative complications resolved by time of discharge. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine the impact of the COVID-19 pandemic on access to rehabilitation therapies and the impact of changes in therapy access on the physical and mental well-being of children with motor impairment and their caregivers. Design: Caregivers of children younger than 18 yrs with childhood-onset motor impairment (primarily cerebral palsy) completed an anonymous survey through the online platform REDCap between May 5 and July 13, 2020. Results: The survey was completed by 102 participants. Before the pandemic, 92 of 102 children (90%) were receiving one or more therapies; at the time surveyed, 55 children (54%) were receiving any therapies (P < 0.001). More than 40% of the sample reported increased child stress, decreased physical activity, and/or decline in mobility/movement. Participants who reported a decrease in number of therapies at the time surveyed more frequently reported lower satisfaction with treatment delivery (P < 0.001), a decline in child's mobility (P = 0.001), and increased caregiver stress (P = 0.004). Five qualitative themes were identified from open-ended question responses related to therapies and well-being. Conclusions: Access to pediatric rehabilitation therapies was disrupted during COVID-19. Disrupted access may be related to impact on physical and mental health. With the expansion of telehealth, caregiver and child feedback should be incorporated to optimize benefit. [ABSTRACT FROM AUTHOR]

Cerebral palsy (CP) neurologic care and research efforts typically focus on children. However, most people with CP are adults. Adults with CP are at increased risk of new neurologic conditions, such as stroke and myelopathy, that require ongoing neurologic surveillance to distinguish them from baseline motor impairments. Neurologic factors could also contribute to the motor function decline, chronic pain, and chronic fatigue that are commonly experienced by adults with CP. Based on a systematic literature review, we suggest (1) guidelines for neurologic surveillance and neurologist referral and (2) clinical research questions regarding the evolving neurologic risks for adults with CP. ANN NEUROL 2021;89:860-871. [ABSTRACT FROM AUTHOR]

Aim: To compare short‐term outcomes between conus medullaris (conus) and cauda equina (cauda) selective dorsal rhizotomy (SDR) techniques in children with spastic cerebral palsy. Method: This was a retrospective review of SDR at a single center from 2013 to 2017. Gait and functional outcome measures were assessed at no more than 18 months pre‐SDR (baseline) and 8 to 36 months post‐SDR (follow‐up). Transient complications during inpatient stay were quantified. Results: In total, 21 and 59 children underwent conus and cauda SDR respectively. Ashworth Scale scores were nearly normalized at follow‐up. Most physical examination and functional measures exhibited similar baseline to follow‐up responses for both groups. From baseline to follow‐up, sagittal plane knee kinematics for both groups significantly improved (p<0.01) by 11° at initial contact, 9° to 10° in stance phase, and 4° in swing phase. Sagittal plane ankle kinematics improved more for the cauda group than the conus group in both stance phase (10° vs 2°, p<0.01) and swing phase (13° vs 3°, p<0.01). Post‐surgical complications were similar between groups. Interpretation: Conus and cauda SDR techniques resulted in similar short‐term outcomes except in ankle kinematics at follow‐up. The cauda group exhibited a large improvement towards dorsiflexion, while there was residual equinus in the conus group despite Ashworth Scale scores normalizing equally in both groups. What this paper adds: Conus and cauda selective dorsal rhizotomy (SDR) resulted in mostly similar short‐term gait and functional outcomes.Conus SDR resulted in residual equinus dynamically, despite normalized spasticity measures.Post‐surgical complications were mostly similar between SDR techniques. What this paper adds: Conus and cauda selective dorsal rhizotomy (SDR) resulted in mostly similar short‐term gait and functional outcomes.Conus SDR resulted in residual equinus dynamically, despite normalized spasticity measures.Post‐surgical complications were mostly similar between SDR techniques. [ABSTRACT FROM AUTHOR]

Examines some cases of pediatric head injury which resulted from all-terrain vehicle accidents. Case histories; Epidemiology of all-terrain vehicle-related pediatric head injury in the 1980s; Recommendations on the safety of all-terrain vehicle driving.

This study analyzed the relationship between electrophysiological responses to transcranial magnetic stimulation (TMS), finger tracking accuracy, and volume of neural substrate in children with congenital hemiparesis. Nineteen participants demonstrating an ipsilesional motor-evoked potential (MEP) were compared with eleven participants showing an absent ipsilesional MEP response. Comparisons of finger tracking accuracy from the affected and less affected hands and ipsilesional/contralesional (I/C) volume ratio for the primary motor cortex (M1) and posterior limb of internal capsule (PLIC) were done using two-sample t-tests. Participants showing an ipsilesional MEP response demonstrated superior tracking performance from the less affected hand (p=0.016) and significantly higher I/C volume ratios for M1 (p=0.028) and PLIC (p=0.005) compared to participants without an ipsilesional MEP response. Group differences in finger tracking accuracy from the affected hand were not significant. These results highlight differentiating factors amongst children with congenital hemiparesis showing contrasting MEP responses: less affected hand performance and preserved M1 and PLIC volume. Along with MEP status, these factors pose important clinical implications in pediatric stroke rehabilitation. These findings may also reflect competitive developmental processes associated with the preservation of affected hand function at the expense of some function in the less affected hand. [ABSTRACT FROM AUTHOR]

BACKGROUND: Transcranial direct current stimulation (tDCS) is a form of noninvasive brain stimulation that has shown improved adult stroke outcomes. Applying tDCS in children with congenital hemiparesis has not yet been explored. OBJECTIVE: The primary objective of this study was to explore the safety and feasibility of single-session tDCS through an adverse events profile and symptom assessment within a double-blind, randomized placebo-controlled preliminary study in children with congenital hemiparesis. A secondary objective was to assess the stability of hand and cognitive function. DESIGN: A double-blind, randomized placebo-controlled pretest/posttest/follow-up study was conducted. SETTING: The study was conducted in a university pediatric research laboratory. PARTICIPANTS: Thirteen children, ages 7 to 18 years, with congenital hemiparesis participated. MEASUREMENTS: Adverse events/safety assessment and hand function were measured. INTERVENTION: Participants were randomly assigned to either an intervention group or a control group, with safety and functional assessments at pretest, at posttest on the same day, and at a 1-week follow-up session. An intervention of 10 minutes of 0.7 mA tDCS was applied to bilateral primary motor cortices. The tDCS intervention was considered safe if there was no individual decline of 25% or group decline of 2 standard deviations for motor evoked potentials (MEPs) and behavioral data and no report of adverse events. RESULTS: No major adverse events were found, including no seizures. Two participants did not complete the study due to lack of MEP and discomfort. For the 11 participants who completed the study, group differences in MEPs and behavioral data did not exceed 2 standard deviations in those who received the tDCS (n=5) and those in the control group (n=6). The study was completed without the need for stopping per medical monitor and biostatisticial analysis. LIMITATIONS: A limitation of the study was the small sample size, with data available for 11 participants. CONCLUSIONS: Based on the results of this study, tDCS appears to be safe, feasible, and well tolerated in most children with hemiparesis. Future investigations of serial sessions of tDCS in conjunction with rehabilitation in pediatric hemiparesis are indicated to explore the benefit of a synergistic approach to improving hand function. [ABSTRACT FROM AUTHOR]

Our objective was to characterize baclofen pharmacokinetics and safety given orally and intravenously. Twelve healthy subjects were enrolled in a randomized, open-label, crossover study and received single doses of baclofen: 3 or 5 mg given intravenously and 5 or 10 mg taken orally with a 48-hour washout. Blood samples for baclofen analysis were collected pre-dose and at regular intervals up to 24 hours post-dose. Clinical response was assessed by sedation scores, ataxia, and nystagmus. Mean absolute bioavailability of oral baclofen was 74%. Dose-adjusted areas under the curve between the oral and intravenous arms were statistically different (P = .0024), whereas area under the curve variability was similar (coefficient of variation: 18%-24%). Adverse effects were mild in severity and not related to either dose or route of administration. Three- and 5-mg intravenous doses of baclofen were well tolerated. Seventy-four percent oral bioavailability indicates that smaller doses of intravenous baclofen are needed to attain comparable total drug exposures. [ABSTRACT FROM AUTHOR]

Abrupt discontinuation of baclofen therapy is associated with a clinically serious withdrawal syndrome. Current treatment modalities are often ineffective. Intravenous ( IV) baclofen is a potential method for preventing or treating baclofen withdrawal syndrome. Objectives To complete a preliminary study of IV baclofen in dogs. Methods Single bolus IV doses (0.5, 2 and 3 mg/kg) as well as multiple dose regimens were evaluated. Sedation and clinical tolerability was assessed by modified Glasgow Coma Scale and Discomfort and Behaviour Scale. Key findings Baclofen concentration-time profiles following single IV boluses were best fit by a two-compartment model which was used to predict plasma concentrations for the multiple dose regimens. The mean distribution and elimination half-lives were 11 min and 222 min, respectively. Maximum clinical effect did not occur until approximately 120 min. The discomfort score increased proportionately with increased single IV bolus doses. Multiple dose regimens resulted in greater than proportionate discomfort scores based on total dose and were generally not as well tolerated. Conclusions If projected for human use, our data suggests that initial IV baclofen doses will need to be reduced by approximately one-third of the usual oral dose, and clinicians should observe patients for several hours before administering subsequent doses. [ABSTRACT FROM AUTHOR]

Presents the personal view of the authors on how the Internet could help Cuba in health research. Belief that the Internet could reduce the brain drain from Cuba but substituting collaboration between countries over competition between countries; How despite poor political relations with the U.S. and restrictions on trade and travel, the Cubans have built a strong biomedical research system which resulted in the first effective vaccine against meningitis B in 1986; Proposal of the creation of online research networks involving researchers from the U.S. and Cuba to be modelled on similar networks that exist in North America, the European Union and Japan; How both communities would benefit; Contention that the proposal would allow Cubans to participate openly at the highest level of research.