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1349 - Spasticity Management of Adults with Schizencephaly

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

MH

Myrna Hanna, DO

Resident
Montefiore Medical Center
Bronx, New York, United States

Co-Author(s)

MK

Min Ju Kim, DO

Resident
Montefiore Medical Center
bronx, New York, United States
MV

Mariana Velazquez-Cano, MD

Scribe/Virtual Operation Manager
Prime Directives PM&R, LLC
Lakewood, Ohio, United States
BL

Bryan Le, MD

Assistant Professor
Montefiore Medical Center
Bronx, New York, United States

Case Diagnosis: Schizencephaly is a rare congenital malformation of the central nervous system that is hypothesized to be due to an arrest of neural migration, resulting in hydrocephalus and ventricular deformations. Manifestations include seizures, cognitive and motor impairments, ranging from hemiparesis to tetraplegia.

Case Description: A 35-year-old male with past medical history of epilepsy and spastic hemiparetic cerebral palsy secondary to schizencephaly, presented to the outpatient spasticity clinic for evaluation for gait difficulty and pain due to left lower extremity spasticity. He tried braces as a child and botulinum toxin in his 20’s with relief. However, the patient was lost to follow up, and spasticity returned, inhibiting his ability to ambulate. His functional goal was to alleviate pain and resume ambulation with a cane. His brain MRI revealed a right open lip schizencephaly, without midline anomalies. His physical exam was positive for a left spastic equinovarus deformity, with a Modified Ashworth Scale of 3 in left ankle invertors and plantarflexors. Given the severity of the spasticity, pain, and reduced function, we proceeded with botulinum toxin injection to the left gastrocnemius and tibialis posterior muscles.

Discussions: Although rare, it is essential for physiatrists to understand the presentation and complications of schizencephaly in the adult population, as well as different treatment approaches. Therefore, management of schizencephaly must be individualized to each patient. Spasticity should be addressed to prevent contractures and improve function and quality of life. Rehabilitation treatment considerations include physical and occupational therapy, medical equipment, bracing, and chemodenervation. If conservative therapies are exhausted, surgical intervention should be considered.

Conclusions: Schizencephaly is a rare etiology for spasticity, however it is crucial as physiatrists to understand its etiology and treatment options to guide functional prognosis and management.