Clinical evaluation of deep cerebellar stimulation for spasticity in patients with cerebral palsy

Background and purpose: The purpose of this study is to present the results of deep cerebellar stimulation in spasticity as a main symptom of cerebral palsy (CP). Material and methods: Thirteen patients suffering from CP were surgically treated with deep cerebellar stimulation of the superior cerebellar peduncle region between April 2003 and April 2007. Outcome was evaluated in 11 out of 13 patients (two patients had their stimulators removed due to infections). The study group comprised 7 women and 4 men (age range: 16-27). Muscle tone was assessed with the 5-point Ashworth scale. Psychomotor status was evaluated with the questionnaire form prepared specially for this study. Each patient was evaluated four times; before surgery, as well as 6, 12, and 24 months after surgery. Results: A great reduction of muscle tone was observed mostly in the first six months. An improvement in psychomotor status during 2-year follow-up was also noted. One patient (9.1%) started walking, and speech improved in 7 cases (63.6%). Among patients with epileptic attacks, we found a decrease in frequency and intensity of attacks. Reduction of pain associated with muscle tone and improvement of mood were noted in all patients. Inflammatory complications occurred in 3 out of 13 cases (23.1%) and led to removal of the stimulating systems. In one case the stimulator was re-implanted successfully and the patient was evaluated in the active group. Two other patients (15.4%) were excluded from the active group due to inflammatory complications. Conclusions: Deep cerebellar stimulation in patients suffering from spasticity in CP is an effective way of treatment; it reduces signs of illness and permits effective rehabilitation, as well as significantly improving the quality of life of these patients. As a non-ablative and reversible procedure it seems to be a safe method of treatment. The most serious complication of the procedure is infection within the operation site.