Peripheral sensory neuropathy observed in children with cerebral palsy: is chronic afferent excitation from muscle spindles a possible cause?

Abstract

Introduction

Peripheral sensory neuropathy is known to be associated with several medical conditions; however, it has not been reported in patients with cerebral palsy. Authors have observed pathological changes in the sensory nerve rootlets taken during selective dorsal rhizotomy. This paper reports a possible novel cause of peripheral sensory neuropathy: the chronic afferent excitations from muscle spindles.

Case report

Sensory nerve rootlets on L5 were taken for histological evaluation from two children with cerebral palsy during selective dorsal rhizotomy, performed for their leg spasticities. Rootlets with clonus reaction against intraoperative electrical stimulation show dysmyelination, and in one child, axonal degeneration can also be observed. Rootlets with normal reaction have only minimum changes on their myelin sheath.

Conclusion

As cerebral palsy is a typical upper motor neuron disorder, peripheral sensory neuropathy is unexplained. Since observed neuropathy is mainly on the myelin sheath, the etiology is considered to be the chronic overload of afferent impulses from muscle spindles in the spastic muscle.