Spasticity explained with options

There have been questions on exactly what Hope's spasticity is and what the dorsal rhizotomy (cutting the nerve fibers) is. I found this article on neurosurgerytoday.org that has a great explination. I have also made some bolded comments within it regarding Hope specifically. Hope this help explains where I am lacking explination.


Spasticity is a condition in which certain muscles are continuously contracted. This contraction causes stiffness or tightness of the muscles and can interfere with normal movement, speech, and gait. Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement. The damage causes a change in the balance of signals between the nervous system and the muscles. This imbalance leads to increased activity in the muscles. Spasticity negatively affects muscles and joints of the extremities, and is particularly harmful to growing children.

Spasticity in Cerebral Palsy (CP)

In a person with CP, brain damage has occurred. For unknown reasons, the damage tends to be in the area of the brain that controls muscle tone and movement of the arms and legs. Therefore, the brains of people with CP are unable to influence the amount of flexibility muscles should have. The command from the muscle itself dominates the spinal cord and results in muscles that are too tense or spastic. People born with CP do not have deformities of the extremities present at birth, but develop them over time. Spasticity of muscles, along with the limitations on stretching and use of muscles in daily activities, is a major cause of these deformities.

Symptoms

Spasticity may be as mild as the feeling of tightness in muscles or may be severe enough to produce painful, uncontrollable spasms of the extremities; most commonly the legs and arms. Spasticity may also create feelings of pain or tightness in and around joints, and can cause low back pain.

Adverse effects of spasticity include:

Muscle stiffness, causing movements to be less precise and making certain tasks difficult to perform
Muscle spasms, causing uncontrollable and often painful muscle contractions
Involuntary crossing of the legs
Muscle and joint deformities
Muscle fatigue
Inhibition of longitudinal muscle growth
Inhibition of protein synthesis in muscle cells
Additional complications

Treatment Options

Physical and occupational therapy (doing)

Oral Medications (untollerable side effects)

BTA, also known as Botox injections have proven effective when used in tiny amounts, by paralyzing spastic muscles. Injection sites are carefully determined based on the pattern of spasticity. (just did and doesn't last this long)

When Botox is injected into the muscle(s), the release of acetylcholine is blocked, resulting in a relaxation of overactive muscles. The injection(s) generally take effect within a few days and last about 12-16 weeks, until new nerve endings grow back and the affected muscle(s) recover. Functional benefits may last longer than this. There are limitations in the number of injections that can be administered.

Surgery

Intrathecal Baclofen (ITB) (what was done and failed twice)

In severe cases of spasticity, baclofen can be administered through a pump that has been surgically implanted in the patient’s abdomen. By delivering baclofen directly to the spinal fluid, a much more powerful reduction in spasticity and pain can be achieved, with fewer side effects. ITB has been found to be extremely effective in treating spasticity in the lower and upper extremities.

Selective Dorsal Rhizotomy (SDR) (what I'm contimplating)

In SDR, the neurosurgeon cuts selective nerve roots (rhizotomy), the nerve fibers located just outside the back bone (spinal column) that send sensory messages from the muscles to the spinal cord. SDR is used to treat severe spasticity of the legs that interferes with movement or positioning. By cutting only the sensory nerve rootlets causing the spasticity, muscle stiffness is decreased, while other functions remain intact. Decreasing spasticity can improve mobility and function, and help prevent severe muscle scarring (contractures), as well as joint and bone deformities. It is utilized most effectively in patients with CP who meet specific criteria. Individuals with the following criteria are not candidates for SDR:

Patients who have experienced meningitis, congenital brain infection, congenital hydrocephalus unrelated to premature birth, head trauma, or familial disease
Patients who have mixed CP with predominant rigidity or dystonia, significant athetosis, or ataxia (the reason there is hesitation)
Patients with severe scoliosis
Patients who will not make functional gains after surgery
The benefits of surgery should always be weighed carefully against its risks. Randomized, controlled clinical trials have demonstrated that a large percentage of CP patients report significant reduction in spasticity and improved function after surgery. However, surgery is not an option for all cases of spasticity.