Cerebral palsy (CP) encompasses a range of neurological disorders that impair an individual’s capacity for movement, balance, and muscle coordination.

The condition arises from damage or irregularities in the developing brain, which hinder its ability to communicate effectively with the muscles. The manifestations of CP can range from mild to severe and may include: exaggerated reflexes, limp limbs or trunk, rigid muscles, abnormal posture, involuntary movements, and an unsteady gait.

CP is recognized as the most prevalent motor disability among children. While there is currently no cure for CP, there is one treatment option that is available to enhance an individual’s quality of life. This procedure is known as Selective Dorsal Rhizotomy or in short SDR.

Dr. Amit Srivastava from Aakash Healthcare Super Speciality Hospital, New Delhi, India, visited the office of Medsurge India and had a one-on-one session with the entire team to discuss how cutting-edge technology is used to diagnose and treat cerebral palsy.

Main Insight of The Session

According to Dr. Amit Srivastava, there is one treatment process that is utilized to treat cerebral palsy patients. This technique is known as selective dorsal rhizotomy, and he was the first doctor in India to successfully perform the procedure following extensive research and experience. 

How to Suspect Cerebral Palsy

Cerebral palsy may be indicated when a child exhibits developmental delays or difficulties with movement, coordination, and muscle tone. 

• Developmental delays: A child might take longer to achieve key developmental milestones such as sitting, rolling over, crawling, or walking. 
• Muscle tone: A child may present with low muscle tone (hypotonia), resulting in a floppy appearance, or high muscle tone (hypertonia), leading to stiffness. 
• Movement difficulties: A child may demonstrate jerky, uncoordinated, or erratic movements, or they may tend to walk on their tiptoes. 
• Postural issues: A child may display atypical posture or show a preference for one side of their body. 
• Swallowing difficulties: A child may experience challenges with sucking, eating, drinking, or managing saliva. 

Symptoms are typically observable before the age of two, although they can occasionally manifest as early as three months.

Selective dorsal rhizotomy (SDR)

A surgical procedure that reduces spasticity in the legs of children with cerebral palsy (CP). Dr. Amit Srivastava explains what it does and how it is carried out in detail.

What It Does

He explains kids with cerebral palsy, SDR, can enhance their mobility and quality of life. Additionally, it can help kids walk on their own with proper physiotherapy after the surgery. 

How it Is Carried Out

During the procedure, a layer of bone is removed in the back of the spine, exposing the spinal cord, and cutting the nerve rootlets. Then identifies and separates the motor nerves from the sensory nerves. A shield is put in the motor nerves to make sure they’re protected during the rest of the surgery.

An electrode is attached to sensory nerve roots. Through the application of electromyography (EMG), the nerves will be stimulated to identify those responsible for spasticity and those functioning normally. After several stimulations, they carefully select which nerves they’ll cut. The neurosurgeon will cut a certain percentage of the abnormal sensory nerves. Which nerves and how many they cut varies from child to child.

Conclusion

The session was concluded with an engaging question-and-answer segment that addressed numerous inquiries from our team. The highlight was his surgical video, which visually demonstrated the procedure and clarified many details.  We are sincerely grateful for the time he dedicated to us, providing a comprehensive explanation of the procedure and sharing insights from his extensive career.

His talent for elucidating the intricacies of the disease in an easily understandable way is remarkable. Additionally, he showcased several case studies throughout the session. We look forward to his next visit to the Medsurge India office, where he can further enhance our understanding of this evolving field.