Results of selective motor fasciculotomy in spastic upper limbs due to cerebral palsy (a review of 30 children and adults)

Objectives: To assess the outcome of selective motor fasciculotomy in relieving upper limb harmful resistant spasticity and thereby to improve motor functions in persons with cerebral palsy. Materials and Methods: Thirty people having cerebral palsy (16 males and 14 females) age ranging from 5-35 (mean age = 12.66) years with upper limb resistant spasticity were studied. The participants having spastic hemiplegia (N = 11), triplegia (N = 9) and quadriplegia (N = 10) were assessed using Modified Ashworth Scale (MAS), Selective Voluntary Control Grade (SVC), WeeFIM Scale and hand function evaluation. Selective motor fasciculotomy (SMF) was performed on musculocutaneous nerve (N = 15), median nerve (N = 35) and ulnar nerves (N = 3) for elbow flexors, pronators and radial wrist flexors and ulnar wrist flexors spasticity respectively. Pre and post op therapeutic exercises were performed. Results: Statistical analysis using Wilcoxon Signed Ranks test showed significant reduction in spasticity and improvement in selective voluntary control, hand functions (grasp to hold a rod) and WeeFIM self care domain. There was no recurrence in spasticity and no complications following surgery. Conclusions: The SMF of musculocutaneous, median and ulnar nerves significantly reduces spasticity in the affected muscle groups and thereby improves the self care (motor) functions in selected people with cerebral palsy who have harmful resistant spasticity without any organic shortening of the muscles. The procedure is safe and the spasticity does not recur.