The book, in its second edition, is devoted to the neurosurgical management of spasticity and focal dystonia. Starting with a chapter on the anatomical and physiological bases of spasticity and a short history of its neurosurgical treatment, it describes the neurosurgical methods currently available. As management differs between adults and children, the book is also structured accordingly, including evaluation, decision-making, Intrathecal Baclofen therapy (ITB), Botulinum toxin therapy and Surgery. The large spectrum of scales for assessing hypertonia, spasticity, dystonia, contracture and joint/bone deformities, as well as the scoring systems for quantifying functional abilities are critically reviewed. Beyond ITB, the neurosurgical options covered include the microsurgical procedures focusing on the peripheral nerves, dorsal roots, Dorsal Root Entry Zone and spinal cord, and their intra-operative monitoring.

In this second edition, the orthopedic surgical interventions available will take a large place, either as alternative solutions , or even better as important complements after spasticity be solved by the neurosurgical treatments.

Based on surgical experience collected with more than a thousand and eight-hundred patients, the book gathers the most important aspects of our present understanding, presented using a practical, educational approach. It stresses the importance of a multidisciplinary approach, including neurologists, pediatricians and rehabilitation specialists. Close collaborations with other surgical disciplines like orthopedic surgery and neuro-urology are outlined.

Marc Sindou, MD and DSc, DHC, is currently Professor Emeritus at the University of Lyon, France. He received his PhD degree on Electrophysiological generators of the cerebral cortex in Humans and his MD degree on Dorsal Root Entry Zone as a target for pain surgery, in the seventies. After his neurosurgical training, he benefited from two Fellowships, first in Micro-neurosurgery in Kantonspital in Zurich with Pr. Gazi Yasargil, then for Functional Neurosurgery in MGH and Harvard University in Boston with Pr. William Sweet. Medical activity in Lyon was then directed to: 1) Functional Neurosurgery of Pain, Spasticity in Adults and Children, Epilepsy and Trigeminal Neuralgias; 2) Microsurgery of Giant Aneurysms, Meningiomas, Venous sinus repair and Cranial Nerve Vascular Compression Syndromes; 3) Neurophysiology applied to Neurosurgery. Surgical activity, together with his superb team and pupils, amounted at twenty-five thousands surgeries over a forty-year period of time. Medical andscientific experience has been published in 709 articles, 43 book-chapters and 7 books, and also through 185 invited-comments or editorials in International Journals. His Research Gate score is 47.60 (i.e, higher than 97.5 % of RG members), with h-index of 53 and h-index excluding self-citations of 48. He was a Founding member of the International Association for the Study of Pain (1976), the President of the World Society for Stereotactic and Functional Neurosurgery (1997-2001), a Vice-president of the European Association of Neurosurgical Societies (1999-2003), a European Teacher in the EANS Training Committee (1985-2014), the President of the French Speaking Neurosurgical Society (2007-2010). He is currently Co- Chairman of the Committee for Stereotactic and Functional Neurosurgery of the World Federation of Neurosurgical Societies. He delivered 331 invited-lectures in 59 different foreign countries. Among many international distinctions, he was awarded the European Lecture by theEANS in 2007, the Spiegel and Wycis Medal by the WSSFN in 2009, the Award of the Ten Masters in Neurosurgery by the World Federation of Neurosurgical Societies in 2009, and the Award of Top-neurosurgeon for CN disorders in 2018. He was honoured by 37 Visiting-Professorships, especially in the fields of Functional Neurosurgery and on the topic of Surgery in the DREZ, a concept that he introduced for Pain and Spasticity in 1974. He fully trained, in addition to several generations of french neurosurgeons, more than fifty foreign promising neurosurgeons, and still keeps fruitful collaboration with a large number of them.

Manon Duraffourg, MD, is a french board-certified neurosurgeon with a diploma in Stereotactic and Functional Neurosurgery. She is developing neuro-orthopedic surgery as an integral part of the management of the spasticity disorders. She has completed a Fellowship in the Neuroorthopedic Department of the Raymond Poincaré Hospital (in Garches, headed by Dr Denormandie) and participates in the Auvergne-Rhône-Alpes regional multidisciplinary team dealing with spasticity. She is also interested in peripheral nerve surgery and pain surgery. She has performed academic and clinical research in the field of pudendal nerve pain, on the occasion of her M.D thesis.

George Georgoulis is a certified Neurosurgeon working at the General Hospital of Athens G.Gennimatas, Department of Neurosurgery. He joined a fellowship program for Neurosurgery of Spasticity directed by Professor Sindou at Hôpital Neurologique Pierre Wertheimer Lyon, University of Lyon 1. He participates on the multidisciplinary team for Cerebral Palsy Children at the University of Athens. He is invited lecturer in several (pediatric) meetings, in particular the European Society of Pediatric Neurosurgery. His publications are cited in prestigious neurosurgical and neurological journals. Among general neurosurgery, his topics of interest are microsurgery for spasticity, intraventricular neuroendoscopy and intracranial meningiomas.

Chapter 1) Introduction.- Chapter 2) History of Neurosurgical Treatment for Spasticity.- Chapter 3) Anatomical Bases of Tone and Spasticity.- Chapter 4) Assessment of Spasticity in Adults.- Chapter 5) Decision-Making for Adults with Disabling Spasticity.- Chapter 6) Intrathecal Baclofen Therapy.- Chapter 7) Botulinum Toxin Injections for Spasticity.- Chapter 8) Peripheral Neurotomy.- Chapter 9) Surgery in the Dorsal Root Entry Zone.- Chapter 10) Spasticity and Hypertonia in Cerebral Palsy: Mechanisms and Surgical Implications.- Chapter 11) Assessment of Spasticity in Pediatric Patients.- Chapter 12) Decision-Making for Neurosurgical Treatment in Children with Disabling Spasticity.- Chapter 13) Dorsal Rhizotomy for Children with Cerebral Palsy.- Chapter 14) Neuro-Orthopedic Surgery for Correction of Spastic Disorders.- Chapter 15) Management of Neurogenic Overactive Bladder.- Chapter 16) Brief on Decision-Making for Neurosurgery of Spasticity in Adults and Children.- Chapter 17) Scales and Forms to Be Used in Practice.