Brain and nerve = Shinkei kenkyū no shinpo
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Spasticity is often observed in patients with brain or spinal cord injuries. Patients with severe spasticity experience considerable difficulty in performing the activities of daily living (ADLs). Baclofen is an agonisit at gamma-aminobutyric acid (GABA) receptors, and is, therefore, a neuroinhibitor, and decreases spasticity. ⋯ All patients implanted with the pump are satisfied with the reduction in spasticity which has improved the performance of activities among wheelchair users and facilitates locomotion. In 2 patients, the implants were removed; in 1, the reason for the removal infection, and in the other was disruption of catheter. Re-implantation surgery was performed on both patients and baclofen treatment was continued.
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Although non-destructive neuromodulation is becoming popular, ablative neurosurgical procedures still play a very important role in the management of harmful spasticity. There are 2 major ablative surgeries for spasticity control. One is selective peripheral neurotomy that is indicated for focal spasticity such as equinus foot and inversion of the foot. ⋯ Recent reports on randomized-controlled studies indicate its long-term effectiveness. A less invasive technique and intraoperative neurophysiologic assessment is important in selective dorsal rhizotomy to maximize clinical benefits and minimize complications. Surgical management of harmful spasticity is a very important and rewarding clinical practice, and should be one of the standards employed in clinical neurosurgical practice.