Neurology and Neurosurgery

PEDIATRIC NEUROSURGERY

All kind of neurosurgical operations can be performed at ACIBADEM Hospitals.

Child Epilepsy Center

In this center, patients undergo medical and surgical treatments of epilepsy. Divisions such as pediatric epileptology, pediatric neurology, pediatric brain surgery, pedagogy, neuroradiology, speech therapy, and physiotherapy work in together in collaboration in this center.

Comprehensive Spasticity Treatment

Monthly Spasticity Councils are held during which a multi-disciplinary team of pediatric and functional neurosurgeons, pediatric neurologists, orthopedists, speech therapists, and rehabilitation specialists evaluate and plan treatments for spastic children from throughout the country. Baclofen Pump Implantations, pallidotomies, thalamotomies, Deep Brain Stimulation implantations, and Selective Dorsal Rizotomies are performed on appropriate patients with promising results.

In each and every council, a high rate of guarantee of treatment by highly experienced physicians and superb medical infrastructure lead to the finest results with success rates that exceed international medical averages.

Cerebral Palsy

Cerebral palsy is a disorder of movement and form linked to damage in the brain caused before or after birth, or during delivery.

Types of Cerebral Palsy

Cerebral palsy portrays different characteristics and is divided into categories in accordance with the location of the damage in the brain.

1- The Spastic type

Spasticity is the increased tone of muscle in the arms and legs. This limits movement. It is divided into types based on the location of the spasticity in the body.

• Diparesis : Spasticity is present in the legs only.
• Hemiparesis: Spasticity is present in one side of the body.
• Tetraparesis: Spasticity is present in the arms and legs.

2- The Dyskinetic types

• The athetoid type: Children with involuntary and slow twirling of the upper segments of the arms and legs
• The dystonic type: Children with spasms similar to the twisting of a pipe or twirling. The spasm increases with voluntary movement. It is observed more frequently in the upper portions of the arms and legs.
• Ataxia: A disorder of coordination. The child has difficulty maintaining balance while walking.
• Hypotonia: No spasms are present in the body. A completely contrary state of looseness is present.

Treatment alternatives in cerebral palsy

Physiotherapy

• To enable the prevention of structural disorders that could result from the spasms
• To decrease spasms through the use of different techniques
• To increase the functional capacity of the child to enable increased independence in the daily life of the child
• To select the equipment needed by the child and to teach the child to use of the equipment

Medical Treatment

• To regulate nutrition
• To hinder the fits
• To take general health precautions
• To decrease spasticity
• Neurosurgical interventions

Spasticity surgery should be undertaken if rehabilitation fails to yield results, spasms make daily care difficult and cause pain upon the child.

Operation alternatives

• Selective dorsal rhizotomy
• Neurotomy
• Deep brain simulation
• Baclofen pump implantation
• Pallidotomy

Orthopedical Interventions

Shortening of the muscles that prevent the growth of the child, or structural irregularities in the joints require orthopedic intervention.

Special Education

Special education in cerebral palsy begins with the interventions upon the child in proportion with his/her physical insufficiency and training of the child on the usage of the supplementary equipment necessary. After independence in the usage of such equipment has been obtained, education is planned in accordance with the intellectual performance of the individual.

Speech Therapy

The patient is evaluated based upon his/her language development and speech particularities, determining the level and method of communication established. Goals of communication aiming to increase independence in daily life are identified, and therapy is provided. Nutritional therapy, including the support and education of the family is provided, based on an evaluation of chewing and swallowing skills. The selection and usage of alternative systems of communication and other therapy tools to enable or advance communication serve as a guide for the family.

Other problems observed in children with cerebral palsy

• Issues of intelligence
• Seizures
• Problems of nutrition (absence of swallowing and chewing skills)
• Speech difficulties
• Issues of teeth
• Vision disorders
• Difficulty in hearing
• Respiratory disorders
• Urinary problems (toilet control)

The treatment of cerebral palsy is done by a multidisciplinary team. All members of the team must be present in the center in which the child with cerebral palsy is undergoing treatment. Periodic councils must be organized, in which all members of the team are present for a joint evaluation of the patient. The objective of such councils is for a simultaneous evaluation of the patient by all members of the team, and the formation of a treatment plan.

Participants of the Council

Treatment of cerebral palsy at ACIBADEM Hospitals is done by multidisciplinary councils. Such teams consist of child brain surgeons, orthopedists, child neurology specialists, radiologists, speech therapists, and personnel of the laboratory for the analysis of movement and walkingThe council is free of charge. Patients are reviewed for participation in the council.

Analysis of Walk

What is an analysis of walk? It is the numerical measurement, identification, and evaluation of movements. A physical examination is not always enough in the identification of the joint or muscle from which arises the walking disorder. In an effort to remedy the walking disorder, the brain utilizes mechanisms of compensation, -thereby making more difficult the determination of the main area or muscles of disorder. Thus, walking analysis technology is needed for the numerical interpretation, recording, and re-evaluation of the problem, and for an objective measurement of the effectiveness of the therapy. The analysis of walk defines in clear terms the disorders in movement, with a high rate of accuracy.

It does not inflict pain or fatigue, and as such, is usually easily adapted by the patients.

There are three different types of analysis in the analysis for walking:

• Analysis of the lower body (applied only upon the pelvis and the legs)
• Analysis of the upper body (applied only upon the shoulders and the arms)
• Analysis of the whole body (applied upon the head, trunk, and the legs, and arms)

What are the advantages of an analysis of walk?

• The clear identification of the illness
• The identification of compensatory (supportive) mechanisms
• Assistance in rehabilitation
• The identification of the surgical intervention to be undergone
• The following-up of the effectiveness of the treatment

What are the areas of application of the analysis of walk?

• Cerebral palsy (congenital muscle spasms)
• Spina bifida (congenital disorders of the spine and the spinal cord)
• Injury of the spinal cord
• Hemiplegia (partial stroke)
• Amputations of the leg (Amputations or absence of the leg)
• Muscular dystrophy (Diseases of the muscle)
• Parkinsonism
• Inflammatory and/or degenerative diseases of the joints
• Head trauma sequels
• Multiple sclerosis (MS)
• Arthroplasty (joint prosthesis)
• Sports injuries

What should you do for an analysis of walk?

• Our center works with appointments. You should schedule an appointment prior to analysis.
• You may obtain information about liaison institutions from the hospital and the call center.
• For your comfort during the evaluation, you may bring tights or shorts with you.

The walking analysis takes approximately one hour, and the evaluation result is presented to you in CD format.