The word management, not cure or results, already tells me this is useless. No one wants a chronic condition managed, they want it cured.
- 1Paediatric Neurosurgery Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- 2Division of Neurosurgery, University of Cape Town, Cape Town, South Africa
- 3Neuroscience Institute, University of Cape Town, Cape Town, South Africa
Traumatic brain injury is a common cause of disability worldwide. In
fact, trauma is the second most common cause of death and disability,
still today. Traumatic brain injury affects nearly 475 000 children in
the United States alone. Globally it is estimated that nearly 2 million
people are affected by traumatic brain injuries every year. The
mechanism of injury differs between countries in the developing world,
where low velocity injuries and interpersonal violence dominates, and
high-income countries where high velocity injuries are more common.
Traumatic brain injury is not only associated with acute problems, but
patients can suffer from longstanding consequences such as seizures,
spasticity, cognitive and social issues, often long after the acute
injury has resolved. Spasticity is common after traumatic brain injury
in children and up to 38% of patients may develop spasticity in the
first 12 months after cerebral injury from stroke or trauma. Management
of spasticity in children after traumatic brain injury is often
overlooked as there are more pressing issues to attend to in the early
phase after injury. By the time the spasticity becomes a priority, often
it is too late to make meaningful improvements without reverting to
major corrective surgical techniques. There is also very little written
on the topic of spasticity management after traumatic brain injury,
especially in children. Most of the information we have is derived from
stroke research. The focus of management strategies are largely
medication use, physical therapy, and other physical rehabilitative
strategies, with surgical management techniques used for long-term
refractory cases only. With this manuscript, the authors aim to review
our current understanding of the pathophysiology and management options,
as well as prevention, of spasticity after traumatic brain injury in
children.
Johannes M. N. Enslin
Ursula K. Rohlwink1,2,3 and 
Anthony Figaji
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