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Long-term effects of selective dorsal rhizotomy in children with cerebral palsy : a systematic review

Tedroff, Kristina ; Hägglund, Gunnar LU and Miller, Freeman (2019) In Developmental Medicine and Child Neurology
Abstract

Aim: To evaluate the long-term effects of selective dorsal rhizotomy (SDR) 10 years or more after the procedure and complications observed any time after SDR in children with cerebral palsy (CP). Method: Embase, PubMed, and the Cochrane Library were searched from their individual dates of inception through 1st June 2018 for full-text original articles in English that described long-term follow-up after SDR in children with CP. The authors independently screened publications to determine whether they met inclusion criteria; thereafter all authors extracted data on patient characteristics, the proportion of the original cohort being followed-up, and the reported outcomes. Results: Of the 199 studies identified, 16 were included in this... (More)

Aim: To evaluate the long-term effects of selective dorsal rhizotomy (SDR) 10 years or more after the procedure and complications observed any time after SDR in children with cerebral palsy (CP). Method: Embase, PubMed, and the Cochrane Library were searched from their individual dates of inception through 1st June 2018 for full-text original articles in English that described long-term follow-up after SDR in children with CP. The authors independently screened publications to determine whether they met inclusion criteria; thereafter all authors extracted data on patient characteristics, the proportion of the original cohort being followed-up, and the reported outcomes. Results: Of the 199 studies identified, 16 were included in this evaluation: 14 were case series and two studies reported a retrospectively assigned comparison group. Evidence concerning function was limited by study design differences, clinical variability, loss to follow-up, and heterogeneity across trials. Interpretation: At 10 years or more follow-up, available studies generate low-level evidence with considerable bias. No functional improvement of SDR over routine therapy is documented. Furthermore, the long-term effects of SDR with respect to spasticity reduction is unclear, with many studies reporting a high amount of add-on spasticity treatment. More long-term follow-up using robust scientific protocols is required before it can be decided whether the use of SDR as routine therapy for children with CP is to be recommended or not. What this paper adds: Ten years after selective dorsal rhizotomy, available studies supply inconclusive evidence on functional outcomes. The long-term effect on spasticity is uncertain, studies reported a substantial need for add-on treatment. Short- and long-term complications seem frequent but are not reported in a consistent manner.

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author
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Contribution to journal
publication status
epub
subject
in
Developmental Medicine and Child Neurology
publisher
John Wiley & Sons
external identifiers
  • scopus:85069928177
  • pmid:31342516
ISSN
0012-1622
DOI
10.1111/dmcn.14320
language
English
LU publication?
yes
id
91430b41-ebbc-47d2-8cce-47913d340ecf
date added to LUP
2019-08-26 11:21:57
date last changed
2020-01-22 07:45:09
@article{91430b41-ebbc-47d2-8cce-47913d340ecf,
  abstract     = {<p>Aim: To evaluate the long-term effects of selective dorsal rhizotomy (SDR) 10 years or more after the procedure and complications observed any time after SDR in children with cerebral palsy (CP). Method: Embase, PubMed, and the Cochrane Library were searched from their individual dates of inception through 1st June 2018 for full-text original articles in English that described long-term follow-up after SDR in children with CP. The authors independently screened publications to determine whether they met inclusion criteria; thereafter all authors extracted data on patient characteristics, the proportion of the original cohort being followed-up, and the reported outcomes. Results: Of the 199 studies identified, 16 were included in this evaluation: 14 were case series and two studies reported a retrospectively assigned comparison group. Evidence concerning function was limited by study design differences, clinical variability, loss to follow-up, and heterogeneity across trials. Interpretation: At 10 years or more follow-up, available studies generate low-level evidence with considerable bias. No functional improvement of SDR over routine therapy is documented. Furthermore, the long-term effects of SDR with respect to spasticity reduction is unclear, with many studies reporting a high amount of add-on spasticity treatment. More long-term follow-up using robust scientific protocols is required before it can be decided whether the use of SDR as routine therapy for children with CP is to be recommended or not. What this paper adds: Ten years after selective dorsal rhizotomy, available studies supply inconclusive evidence on functional outcomes. The long-term effect on spasticity is uncertain, studies reported a substantial need for add-on treatment. Short- and long-term complications seem frequent but are not reported in a consistent manner.</p>},
  author       = {Tedroff, Kristina and Hägglund, Gunnar and Miller, Freeman},
  issn         = {0012-1622},
  language     = {eng},
  month        = {07},
  publisher    = {John Wiley & Sons},
  series       = {Developmental Medicine and Child Neurology},
  title        = {Long-term effects of selective dorsal rhizotomy in children with cerebral palsy : a systematic review},
  url          = {http://dx.doi.org/10.1111/dmcn.14320},
  doi          = {10.1111/dmcn.14320},
  year         = {2019},
}