Niall Eames

The effect of botulinum toxin A on gastrocnemius length : magnitude and duration of response

Thirty‐nine ambulant children (22 with hemiplegia, 17 with diplegia) with spastic cerebral palsy receiving isolated gastrocnemius muscle injection with botulinum toxin A were studied prospectively. The children had a mean age of 6 years (range 3 to 13 years). Measurement of gastrocnemius muscle length was used to estimate the dynamic component of each childs spasticity and to quantify the response. There was a strong correlation between the dynamic component of spasticity before injection and the corresponding magnitude of the response after injection. Children undergoing repeated injections showed similar correlations. A strong correlation was found between the duration of response and the dynamic component. Children with hemiplegia showed twice the duration for a given dynamic component compared with those with diplegia when injected with the same total dose per unit body weight. Long‐term lengthening did not occur for the cohort, although some patients showed a response at a 12‐month follow‐up. By delaying shortening, the injections may have a role in delaying the need for surgery. Injections were well tolerated with few side effects.

Defining gastrocnemius length in ambulant children

Abstract This paper describes a system to calculate gastrocnemius muscle length from three dimensional kinematic gait data and anthropometric measurements of children taken from MRI scans. As well as describing the simple model that may be applied to existing gait data, the anthropometric data for 15 able-bodied children is presented. The model is then used to describe gastrocnemius muscle lengths and the effect of different pathologies on muscle lengths by looking at cohorts of able-bodied children, children with a hemiplegic or diplegic pattern of cerebral palsy, a child undergoing tendo Achilles lengthening and a child with burns to his lower limbs. The results show the importance of using muscle lengths as part of a clinical assessment and the need to take the effects of skeletal growth into account when developing models for use in a paediatric population.

'Scan-negative' cauda equina syndrome: Evidence of functional disorder from a prospective case series.

Abstract In the first prospective comparison of ‘scan-negative’ (n = 11) and ‘scan-positive’ (n = 7) patients with cauda equina syndrome (CES) we found that Hoovers sign of functional leg weakness but not routine clinical features differentiated the two groups (p < 0.02). This offers a new direction of study in this area, although magnetic resonance imaging is still required for all patients with possible CES.

Influence of timing of surgery on Cauda equina syndrome: Outcomes at a national spinal centre

Purpose There is no doubt that the best outcome achieved in Cauda equina syndrome (CES) involves surgical decompression. The controversy regarding outcome lies with timing of surgery. This study reports outcomes on a large population based series. Timing of surgery, Cauda Equina syndrome classification based on British Association of Spine Surgeons (BASS) guidelines and co-morbid illness will be assessed to evaluate influence on outcome. Materials and methods A retrospective review of all patients surgically decompressed for CES between 01/01/2008 to 01/08/2014 was conducted. Patients with ongoing symptoms were followed up for a minimum of 2 years. Cauda Equina Syndrome (CES) was classified according to the BASS criteria: CES suspicious (CESS), incomplete (CESI) and painless urinary retention (CESR). Time and symptom resolution were assessed. Results A total of 136 patients were treated for CES; 69 CESR, 22 CESI and 45 CESS. There was no statistical difference in age, sex, smoking status and alcohol status with regards to timing of surgery. No correlation between increasing co-morbidity score and poor outcome was demonstrated in any subgroupAll CESR/I patients demonstrated some improvement in bowel and bladder dysfunction post-operatively. No significant difference in improved autonomic dysfunction was demonstrated in relation to timing of surgery. CES subclassification may predict outcome of non-autonomic symptoms. Statistically better outcomes were found in CESS groups with regards to post-operative lower back pain (P 0.049) and saddle paraesthesia (P 0.02). Conclusion Surgical Decompression for CES is an effective treatment that significantly improves patient symptoms including bowel and bladder dysfunction Early surgical decompression <24 h from symptom onset does not appear to significantly improve resolution of bowel or bladder dysfunction.