Stepwise surgical management of spasticity and dystonia in severe pediatric cerebral palsy: a case report involving selective dorsal rhizotomy, intrathecal baclofen therapy, and deep brain stimulation.

Children with severe cerebral palsy often encounter significant challenges due to refractory spasticity and dystonia in their upper and lower limbs, which are unresponsive to pharmacological treatments. Selecting appropriate surgical interventions is essential for effective management of these severe symptoms. We present the case of a 10-year-old child with severe cerebral palsy who experienced intractable spasticity in both upper and lower limbs that was not controlled by medication. Weighing less than 20 kg, the child initially underwent selective dorsal rhizotomy (SDR), which significantly reduced lower limb spasticity and contributed to an increase in body weight. Approximately 1 year later, to address persistent upper limb spasticity, intrathecal baclofen therapy (ITB) was administered, resulting in a marked improvement in spasticity and quality of life. However, nocturnal dystonia continued to disrupt sleep. As a result, 2 years after ITB, deep brain stimulation (DBS) was performed, leading to substantial relief from both spasticity and dystonia and further enhancing the child's overall well-being. In cases of severe cerebral palsy, a sequential, symptom-targeted surgical approach can be highly beneficial. Implementing a strategy that includes multiple interventions tailored to the patient's evolving clinical needs can significantly improve outcomes and quality of life.