Conditions & Treatments
Pediatric Movement Disorders
Texas Children’s Hospital has a multidisciplinary team of physiatrists, neurologists, neurosurgeons, physical therapists, nurses, social workers, and orthotists that work together to treat pediatric movement disorders. Our team works collaboratively to determine the best treatment plan for children with spasticity, dystonia, and other conditions. Texas Children’s Hospital offers its own on site inpatient rehabilitation unit to meet the needs of our patients with movement disorders.
What is spasticity?
Spasticity is a condition in which a person’s muscles are continuously contracted. This constant contraction causes tightness of the muscles and affects a person’s movements, speech, and walking. Spasticity is caused by an injury to the area in the brain or spinal cord that controls voluntary movement and affects communication between the brain and spinal cord. Spasticity can negatively affect the muscles and joints of growing children.
Pediatric spasticity can be caused by many different things including cerebral palsy, genetic disorders, traumatic brain injury, spinal cord injuries, and strokes.
Treatment Options for Spasticity
- Intrathecal Baclofen (ITB)
Intrathecal baclofen is a medicine used to treat spasticity. When administered into the area surrounding the spinal cord, a patient can often maximize the benefits of the medication, while experiencing fewer side effects than when taking oral baclofen.
Before placing a baclofen pump patients may undergo an intrathecal baclofen trial to see if intrathecal baclofen is an option to treat their spasticity. During this procedure the patient is asleep (sedated). A spinal tap is performed by Neurosurgery and baclofen is injected into the area around the spinal cord. The patient is woken up and taken to the recovery area. In the recovery area the patient is assessed by a physical therapist and Physical Medicine and Rehabilitation (PM&R) to see if intrathecal baclofen is effective for their spasticity.
An intrathecal baclofen pump placement is an operation performed by a trained Neurosurgeon or orthopedic surgeon, in which a small pump is placed into the abdomen and is programmed to infuse baclofen through a catheter directly into the area around the spinal cord. After implantation of the baclofen pump, patients are hospitalized for 3-5 days to allow our team to adjust the dose of the medication using a programmer that is placed on the outside of the abdomen. Patients are discharged when their tone improves and the potential side effects subside.
After baclofen pump implantation, patients are placed on activity restrictions for 3 months and their wheelchairs are slightly reclined to allow for complete healing of the surgical incisions. Subsequent follow-ups for continued adjustment of the medication dose and pump refills are done through the PM&R service. Pump refills occur approximately every 3-6 months. After a baclofen pump is implanted patients no longer need to take oral baclofen. The pump is surgically replaced every 5-7 years due to battery life.
- Selective Dorsal Rhizotomy (SDR)
A selective dorsal rhizotomy is an operation performed by a trained neurosurgeon to permanently treat spasticity in the legs caused by abnormal communication between the brain and spinal cord. During a selective dorsal rhizotomy patients are put to sleep in the operating room. A trained neurosurgeon makes an incision between the first lumbar vertebrae and the sacrum. The nerves are exposed and carefully tested to determine which ones are abnormal. The nerves that are found to be functioning abnormally are selected out and cut. The nerves do not grow back together resulting in long term improvement of a patient’s spasticity.
After a rhizotomy a patient will recover for about 5 days in a regular hospital room. Patients will have an epidural catheter to help with their post operative pain. The Pain service at Texas Children’s Hospital assists the neurosurgery team to keep patients comfortable and minimize their pain. After a rhizotomy, a patient will have difficulty walking because of their weakness. They will spend 4-6 weeks in the inpatient rehabilitation unit and receive both physical and occupational therapy to strengthen them and improve their function. It is very important for a patient to participate in therapies following a rhizotomy. Sometimes a patient uses a wheelchair during this period if they do not begin walking right away.
What is Dystonia?
Dystonia is a neurologic movement disorder consisting of involuntary, sustained or repetitive, patterned muscle contractions, frequently causing twisting or other movements or abnormal postures. Dystonia can be painful, and can affect the muscles of the torso, limbs, neck, or face. There are many causes of dystonia, including genetic conditions, abnormalities of the brain, strokes, or degenerative diseases.
Treatment Options for Dystonia
Dystonia can be treated with medications that are prescribed by a trained Movement Disorder Neurologist.
Tics and Tourette Syndrome
Tics are sudden, brief, repetitive movements or sounds which can interrupt tasks and cause considerable discomfort. These can often successfully be treated by a movement disorders specialist with oral medications, injections, or sometimes with behavioral interventions. Patients with severe tics that are refractory to other therapies may be candidates for deep brain stimulation surgery. Criteria for Tourette syndrome are met when a patient has at least one involuntary sound (vocal or phonic tic) and at least two involuntary movements (motor tics), with a period of at least one year since tics began.
Chorea consists of irregular, purposeless, involuntary writhing or dance-like movements that flow from one part of the body to another. Chorea can be caused by numerous different disorders, including genetic and autoimmune causes, injury to deep structures of the brain, and other disorders. Chorea can often be treated successfully with medications by a movement disorders specialist.
Tremor (shaking) is an involuntary, rhythmic, oscillatory movement about a joint axis. There are numerous causes of tremor in the pediatric population, including genetic disorders, tremor associated with dystonia, drug-induced tremor, and others. Tremor can often be treated successfully by a movement disorders specialist with medications, injections, or other treatments.
Myoclonus is a disorder consisting of involuntary, brief, jerk-like contractions of a muscle or muscle groups resulting in a sudden movement. This condition can be caused by different types of genetic disorders, and cerebral malformations, and injuries to the brain or spinal cord. Myoclonus can be a symptom of underlying seizures, or can be non-epileptic. It can often be treated successfully by a movement disorders specialist with medications.