Chronic cerebellar stimulation in cerebral palsy

Chronic Cerebellar Stimulation in Cerebral Palsy L. P. Ivan, M.D. E~ C G. Ventureyta, M~D., J- Wiley, MA)., D. lNy|e, M,g~ E~ Pre~man, PhA). R~ Knights~ Ph.D., C. Gn~man, M.D,, and D. Uttley~ T, Eng with an intelligence q~ouem {IQ) ~k~w ~ . patients with C~ ~an a~no~malitie~ not compatib|e with the diagnmis of cerebral palsy, patients with minimal to slight invoivemet~t and with pure ataxic forms of cerebral patsy, and children ~tow 2 years of age were exalt,tied frc,m the study~ ~ = i ~ e n t was desgntd and manufactured by Aver~. Mix,rarefies (Farmingdale. NYL Two identical e|eetr~x{e pa&s were u~ed. each with t~ur platinum buttons. But|am 1 and 3 of each pad ate connected and comti~te one termirmi; ~attons 2 and 4 d each g~d ate aim connected and cam|irate anothe~ te=nmaL ~'~e d e c t t ~ e pads connect with an ahemate Ix)le, radio r~eiver through a lead wire arising from the electrodes~ ~ e dec|retie pa& and radm receiver a e f~ily implantmd at the time of the operation. The prco~rative and postoperative asse~sment~ were ~arittg the past five vear~, several repom have indicated tamed out by a team of ~p~-c~ah,u in the fo|towin~ areas hoio~y. I:u:n~ficiaI effect, from chronic terra.liar stim~latkm in pa* re~piramr~ ph>iotogy, s[~vh ~thokgy. ne~ tient~ ~ith cereb~M palsy, Ca:,~\~r and h~ ~.ociate~ 12-41 ncutok~*;, occuvat~ona| therapy, a~d physiotherapy~ ln~ have rm,rt~d comidemble improvement in stmh patient~ traof~mtive calibratum of the stimulamr~ impe£ance meaDavis |51 simply staid that eve~+ patient suffering from surement, and postoperative check of the stimu|~, s ~ | retire eel&rat palsy Ngnefit>tram chrcmic cerebelhr stimulation. were &me by a bie~nginee~. A~ N~t of the s of ~he ~kuIL while (2(x,er | I ] and Penn 17t were more ca~tiou~ in their a~.~ment, aR patient~ had rt~ntge relx,m on certain ~nefit~ in most patients. E n c o u ~ d by decm~ncephalo~ram,, and ~ ~¢am~ In ~Jdition to the~ th~,e ~ i t l v e re~rts~ the Neuro~utgical Division of the pr~×edures, p~ychdogical a~se~sment and IQ meamreChddwn; t.h~piml of E,utem Ontarm began ~mNantin~ menL, were made. Ave~d>avi, Cerebellar Stimulator> m 1977. ~N~epreliminary rmulu of this study were re~rte3 by Ventureyra and S o , c a | Technique The surgical t¢~hmque u~xi i~ thi~ e.roup of patient~ was h'an in 1978 |9}. Twelve patients suft~¢ing from cerebral palsy of the spas- that des.robedby Dav,~ 15i with ~omc aherg~tion~ 161. The nc athetoid r~pe received cerebellar implants for chronic fotlowin~ further m~×hficanon~ were made in Davids techcete~llat mi~ulation t~tween Julv~ 1977, and S~ptember, nique ( l ) the green| was placed in a prone g)~ition rather 1978, ~ e age of the~e patients r |~tween 3 and 30 than m a sitting ix~sition during o?.erat~m; (2) the receive~ vea~s~ Eleven patiet~ts had a normal compute|lard rom~. antenna wa~ #ace,{ in a >nkgutaneous pocket met the right graphic (C~) scan. The etidogies of the cerebra| paby tm~:ms mu~:b instead of the anterior che>t wail; and {3) ~ere prenatal causes m 5 gatient~ neonatal asph~+xia m 6 mu~g|e ~ltche~ were u~,edn,~mne|y over the Jura| openin~ patienb and pasmatal encephalm~ in I gatient. Patients %~ check the apparatus in s~tu ~fore closure of the recision, a 10 & m ~emtor wm phced k~vxeen the ~eceiver and the ele~m~de a~ay~ to pe~i! o~:Rk'
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limW~ fi~r a pu++e width +if 0++ tm|hw+:onJ>+ +t 2v+O+he:+ + |+++|tern Te+t+++~ natm~ pt+|>e> Fir ,.~+cond m a 7 mi++uto- ~+f+, 7 mimaes oft ++++£p+w~h cgcle Imp,adance was mea+u+ed at ~he :i+++,,~,f the oI,~,tl+ } +e~ | ~ ++it +~+ ~+on n 9 p~men~ and rar+~:cdfam~ ZS0 +~+6d'0 ohm with m P,m¢+++ X+++ ~ ;+,+~D average ~+f 4v'+£+ ~+}+tt++ghi+ ialH++} +tim+i|at~m wa+ fu+the+ moJi+ied ++~+|mile pot{e++t,~ }+++';m+~*+O{ ~ q + to+eml+e o+++the } it+it+a| ~imo+Jl++t+:{ {t+¢+em{+ + ?,I++m ra+ient* ~,ete d++cha+~cd f+,,m :he ho+it;d ++p+ + pmxir++a+eIy tin d.+y~afte¢ the opemtio+. |~+¢i01+d+~:har~e, 4 + at/p;ments had toentgenogt;+m- d ~he che~ and the >ka|t + 4 m ~,rder to check the ~x~sit/on d ~he ele,:m~Je,- and the ~e+ e 4 crave+' at}ten+z +a~ ~ve|t a,. +l~e + After 7 5 mhe pa++en£s di~<:hatve+ ~he b~+en;me+t came.+: ,,+~+tpen++dic > + ek'ctroni¢ ch~-~ks ~gthe r,ld~ freq~ency c h a t re, ve~i~} tha: '+ +~ the m m w u s readied the cerebellum. + P~+.~tol:erative EvMumtkm Pt+stop+cpat!~e evahlation were made f ~eek, ~ re, ruth + 6 ++w+r+O++sand | 2 month~ alter ~he opcm~on u+mt ~p+¢ech+ ++it+ m++cle tO~e+ :twoh+n¢+ttv movemei+~++ ~+~¢ee o{ da~4ieg+ anJ activitie+ +ff da~ly ~+vm+ as pamme+~.+,+ The

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Dt~w*|m~ is vee} d~f~cuh m a~,.~.s~o|~ectiveh'~ pamcu}ad~ bvcau,~~dn~*iing changes fr~m day m d,w and varies greatly unde~ ~he m~lnence of &ffe~ent ¢}~¢mn~tanees. Eleven pa* t i e n ~ exhibtted i n e : e ~ d dt~iing lTahle 5L T~,~ of {i~e~: pade~ts s h m ~ | n~ m ~ m w m e n t , at~d one ~.,vame ~ o ~ e Foyer{~he~s t'~.came ~'or~ immediately after lhe ~D'rati~m bu{ |mpnw~d ~ignifieanriy later on. Fc~,t patients s|u:,wed digh~ ~o m~.,|em~e improvemen~ immediately R~I|owing ~he l ) ~ of the 12 patients. 2 had mo.letate dih~t,|tm~ m r~effotming aetivit~e.~d d a i | v hying, ~ ha.| ,
One of them ~ecovemt .,.~m:awt~mk~ 2 law~ ~hm~d S ~ a p h y ~ e u atb~ mfeet~on C'~e of d~e*e patten{, ~e. qtmed ~he r e m ~ a | ~f ~he ~mp|an~ a=d the o{het had a re~mp~an~a~i~m of the tece~ve~ ove~ the ~D~,ite ~ape:mm m d e ~'~{h ea.es were ~te,~ed heavih ~-~th annbiod¢~ The g~ien~ ~e.4uirmg removal of lhe ~mp~an~ shmv~.d donee, co;rang of O~e elecm~e~ and b~opsi~> ~g the
84

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stx~nded ro ligation of the wire rennet and continuous CSF lumbar drainage for one week, Aithough n o surgical mtmaiiw c
were carried out. Evidence of cerd,cllar &re,age was confirmed with cer¢l~:l|ar biopsy in one ca~:. Char re.~ufts ~ c m to s u p r ~ the statemem of Whittaker [10} who found d~at i~* a &mb|e.biind cn~,~sm'ct ,m~dy neither the padents nor the a~se~u~r~ were abD m tell whether the stimulator Wae. on or Olaf. In spite of our negative results, we £ed that this methc~J deserves i~rther at{emi~m ~sing a &mb|e.blind pm~F<'ctive study, In wdditiom timber criteria f o r patient sdection sho~ld b~: used, a~a] nonver~l, q~adtipatetic, and athemid padem, shcmld be e x d u d o L

Refereffce~

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nc~m~lo~¢Md~e:~x~ Lan¢¢~ ~ 1}21~ 1073 c~¢¢Nal pa|~ J F|a Med A ~ ~}:91C~-9~2. 1976 6 h'.m LP, \'e~m~e~ E(X;, The ~cchmq~ ~g ¢~eb~|h~ ira#am ~o~ d~romc ee~ebdla~~mmia~um~ah,m~cO, An~ R Co~|~ - ~ a m S ~ (£~da, 12:27, 197~ 7 P~rmRD. (k*~d~ebGL, A~a~a| GG ~b,Alar ,mm~kmoum man Q,~a~ma~ve ehan~t~, m .,p,~m¢*t,~J Ne~m~tg 48:77~-7~6, 1978 S I p~mARM, C~tx,~|S ~me~etm,phySkd~v~cal¢ff~t.~ofeer,:bd~ 9 'C~m~¢ym~(aG~ lv;m [P~ LThmmc¢c~ebclla~mmulatum m