P 1175. Increased Quality of Life in Children with Cerebral Palsy after Selective Dorsal Rhizotomy
30 October 2018 (online)
Background: Cerebral palsy (CP) describes a group of conditions, originating from irreversible but not progressive damage of the brain during the neonatal period. About 2 in 1,000 neonates are affected by some sort of CP. Patients with CP are prone to develop increasing muscle spasticity, a progressive loss of selective motor control, and, subsequently, are likely to have contractures of the joints. The bilateral spastic CP of the lower limbs is the most common type of CP. Affected children experience limitations in their physical mobility which can impact their social life in school and spare time and therefore has consequences on their quality of life (QoL).
Selective dorsal rhizotomy (SDR) has potential to reduce these deficits through improvement of motor control. In the procedure, selected dorsal rootlets are identified by their pathological answer to a stimulus in an electrophysiological assessment and subsequently severed to reduce spasticity in CP.
Objective: The aim of this study is to evaluate how SDR affects subjective QoL of children with bilateral spasticity of the lower limbs, how parents perceive the QoL of their children, and which additional factors have an impact on these evaluations.
Method: In total data from 60 children who underwent SDR for bilateral CP of the lower limbs in the years 2008 until 2014 and who had evaluated their QoL before and after the procedure were assessed. QoL was evaluated preoperative as well as 12 and 24 months after SDR using DISABKIDS questionnaires according to the children’s age and chronic disease. Motor skills were assessed by GMFM-88 and categorized using the gross-motor function classification system (GMFCS).
Results: Evaluating the questionnaires, this study found an increase of the subjective QoL of the children 12 and 24 months after SDR. Compared with 1,152 chronically ill children (e.g., asthma, diabetes, and epilepsy) of the DISABKIDS European field study, this cohort has been on a lower level of QoL pre- and also postoperative. When compared with the 84 children with CP in the field study cohort, this study’s patients undergoing SDR showed better results in the QoL questionnaires, especially postoperatively. Parents rated the QoL of their children lower than they themselves did. In questionnaires after the procedure, this gap grew bigger. This difference underlines the results of the DISABKIDS field study. This study expects to show a correlation between subjective QoL and objectively measured improvement in motor skills using the GMFM-88. Furthermore, the data have implied a connection between QoL and the type of school attended by the children—patients attending a regular school were more likely to have lower QoL despite good motor skills than those attending a school that accommodated to their special needs.
Conclusion: SDR improves QoL in children with spasticity of the lower limbs but is dependent on a supportive environment and the expectations that are put on the procedure and on the patients. These results are in line with the DISABKIDS field study results showing that parents rate their children’s achievements lower than the children do so themselves.