A proposed preintervention framework for neurosurgery in children with medically refractory hypertonia: a scoping review

OBJECTIVE: Pediatric movement disorders (PMDs) frequently require escalating neurosurgical therapies. Institutional studies describe local preintervention evaluation for selected PMDs; however, no international consensus guidelines exist. The authors aimed to review preintervention screening for PMDs and present a suggested preintervention framework for children with PMDs who might benefit from neurosurgery. METHODS: A scoping review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines adapted for scoping reviews (PRISMA-ScR) and the JBI scoping methodology to compile information about the preoperative evaluation of PMDs across various institutions. Data were synthesized and a preintervention framework was developed. RESULTS: Twenty-one studies were included. Presurgical evaluations included multidisciplinary evaluation, imaging, physical therapy, occupational therapy, gait analysis, nutritional analysis, and genetic analysis. These data were used to create presurgical algorithms for pediatric hypertonia defined by dystonia, spasticity, or mixed hypertonia. Each diagnosis-specific algorithm guides the clinician through the recommended evaluation and toward the appropriate neurosurgery. CONCLUSIONS: An evidence-based, structured, diagnosis-related presurgical algorithm for PMDs could mirror existing approaches for medically refractory epilepsy and improve patient care via standardization of indications, workup, and recommendations. This scoping review identifies gaps in all major aspects regarding the presurgical workup of PMDs and suggested surgical plans.