Progressive scoliosis in early, non-progressive CNS injuries: role of axial muscles

Forty-three patients with progressive neurological deficits involving axial musculature, starting 3-6 years alter non-progressive brain injuries insul ts are described. Losses of function followed period of several years oi st able motor deficits. Subsequent losses were stereotypic, with loss of ambul ation and scoliosis, followed by loss of word articulation, malalignment of the mandible and ultimately neurogenic impairment of swallowing. Physical therapy, serial castings and spinal instrumentation palliated specific musc uloskeletal problems but did not alter the relentless loss of various funct ions. The balanced action oi paired axial muscles (i.e. spine, proximal mus cle groups of the lower extremities, oropharynx, mastication) is regulated by the brainstem with modulation by the cerebral hemispheres. The clinical evolution in these patients suggest that, in the absence of normal input fr om the cerebral hemispheres, some patients have a progressive loss of these brainstem mechanisms. The most resistant functions (last ones to be lost), seem to be the ones phylogenetically most relevant for survival, such as s uction and swallowing.