Systematic review evaluates SDR, ITB, DBS, and other interventions for functional outcomes in ambulatory children with cerebral palsy.

This systematic review assessed multiple interventions for ambulatory children with cerebral palsy, including those with dystonia-predominant phenotypes or mixed presentations. The interventions evaluated included Selective dorsal rhizotomy (SDR), combined dorsal-ventral rhizotomy, peripheral neurectomies, intrathecal baclofen (ITB), deep brain stimulation (DBS) targeting the globus pallidus internus, emerging cerebellar DBS, spinal cord stimulation (SCS), and focused ultrasound. Primary outcomes focused on functional status, motor function, quality of life, muscle tone, walking speed, and spasticity reduction.

Surgical and neuromodulation approaches demonstrated varying degrees of efficacy. SDR was identified as a novel treatment option for spastic diplegia in ambulatory children. Combined dorsal-ventral rhizotomy showed promise for mixed presentations. Peripheral neurectomies provided targeted management with sustained improvements in muscle tone and walking speed for focal spasticity. Intrathecal baclofen (ITB) effectively reduced spasticity and dystonia, although scoliosis progression requires monitoring with this therapy. DBS targeting the globus pallidus internus demonstrated efficacy in dystonia-predominant cerebral palsy, with younger patients showing greater improvement. Emerging cerebellar DBS approaches show early promise for spasticity and mixed presentations.

Spinal cord stimulation (SCS) may benefit select patients with spasticity or painful dystonia, though evidence remains limited. Focused ultrasound represents a novel noninvasive ablative option currently under investigation. Safety data indicated infection rates associated with ITB, while serious adverse events and discontinuations were not reported. The review noted that treatment selection requires multidisciplinary evaluation considering movement disorder phenotype, functional goals, patient age, and family factors.

Key takeaway: Consider multidisciplinary evaluation for treatment selection in ambulatory cerebral palsy patients.