Children with cerebral palsy will now be able to have a surgical procedure that can improve their ability to walk, after analysis by the NIHR Guy's and St Thomas' Biomedical Research Centre (BRC) and King's College London showed it to be effective.
The procedure, known as selective dorsal rhizotomy, involves cutting some of the sensory nerves from the legs as they enter the spinal cord in order to relieve stiffness, improve mobility and reduce children's pain levels. The operation is irreversible, and it had not previously been fully established whether it helped to improve children's quality of life, or what the longer term effects were.
Because of the lack of evidence of the benefits of the procedure, NHS England established an innovative study that assessed eligible children with cerebral palsy before and after the operation. Researchers at King's College London were commissioned by the National Institute for Health and Care Excellence (NICE) to find out whether selective dorsal rhizotomy did improve outcomes for these children with cerebral palsy.
Cerebral palsy is the name for a group of lifelong conditions that affect movement and co-ordination, caused by abnormal development or damage to the brain that occurs before, during or soon after birth. In the UK around 1,700 children every year are born with cerebral palsy. Treatments include medicines to relieve muscle stiffness, pain relief, and physiotherapy to aid walking.
Professor Janet Peacock, data analytics co-lead at the NIHR Guy's and St Thomas' BRC and Professor of Medical Statistics at King's College London, said: "We were commissioned to fill an evidence gap around selective dorsal rhizotomy for treating cerebral palsy - previous trials didn't look at children's quality of life and there was not enough evidence about how children fared in the longer term. Those were both important aspects to be considered. Our study provided convincing evidence that the procedure helped the children.
"NHS England have now decided that this procedure will be funded as a direct result of this innovative project. It's great to get this decision so that it will make a difference to patients."
Five centres were selected to perform selective dorsal rhizotomy, resulting in 137 children receiving the procedure. The team at the NIHR Guy's and St Thomas' BRC and King's Technology Evaluation Centre (KiTEC) then collected and analysed data on patients' progress for two years after their operations. Their results, published in The Lancet Child and Adolescent Health, showed the procedure benefitted children by improving their movement, quality of life and levels of pain. They also found that there were no significant health risks to the children from the procedure.
This evidence was strong enough that NHS England has decided to fund the procedure for eligible children aged 3-9 years.
Dr Chris Verity, a consultant paediatric neurologist at Addenbrookes Hospital, chaired the steering committee set up by NHS England to plan and oversee the study. He said: "This procedure is for children with cerebral palsy who can walk, but are having problems because stiffness in their legs leads to pain and a lack of control over movement. Because it involves cutting nerves, the procedure is irreversible. It was key to gather robust evidence of improvement after the operation when deciding whether or not it should be routinely available for suitable children in England and Wales.
"This study shows objectively that the procedure does improve motor function, and doesn't have dangerous side effects. For some children with cerebral palsy and their families this could really improve quality of life and help children walk more easily and without the use of walking frames and other aids."
Health Secretary Matt Hancock said: "This is a revolutionary treatment which has the power to transform the lives of young children with cerebral palsy and give fresh hope to their families.
"Every parent dreams of seeing their children live long, healthy and happy lives and I'm absolutely delighted the NHS is funding this new procedure as part of our Long Term Plan."
Meindert Boysen, director of the Centre for Health Technology Evaluation at NICE, said: "NICE welcomes the results of this study, which was commissioned and funded by NHS England and managed by NICE as part of the Commissioning through Evaluation programme. The study supports the recommendation for selective dorsal rhizotomy as an option to improve walking ability in some children we made in our 2012 clinical guideline on the management of spasticity. This addition to the evidence base means that some children with cerebral palsy will now be able to access this treatment within the NHS in England."
John Stewart, director of specialised commissioning at NHS England, said: "Thanks to this study the NHS has been funding this innovative treatment for children. As well as being fantastic news for patients and their families it is also an example of the kind of innovations that the NHS will continue to deliver as part of the Long Term Plan."
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Contact: Anna Perman, Communications Manager, NIHR Biomedical Research Centre at Guy's and St Thomas' and King's College London tel: 07717 817 714 or e-mail: anna.perman@gstt.nhs.uk
'In the UK around 1,700 children every year are born with cerebral palsy' - source: http://www.cerebralpalsy.org.uk/
Note to editors: About the NIHR Guy's and St Thomas' Biomedical Research Centre
The National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at Guy's and St Thomas' NHS Foundation Trust and King's College London works to develop and deliver new medicines and diagnostics to patients, drive research and innovation into the NHS, and provide national systems leadership for maximum impact to patients.
With our research activity organised into nine themes, each holding an individual Athena Swan Silver award highlighting our commitment to equality and diversity, and supported by our interdisciplinary, world leading infrastructure, we are poised to deliver the next step change for the health and wealth of our nation. http://www.guysandstthomasbrc.nihr.ac.uk/
About the NIHR
The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:
- · Funds, supports and delivers high quality research that benefits the NHS, public health and social care
· Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
· Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
· Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
· Partners with other public funders, charities and industry to maximise the value of research to patients and the economy
The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.
This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to this data. The NIHR recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care. http://www.nihr.ac.uk/patientdata
About King's College London
King's College London is one of the top 10 UK universities in the world (QS World University Rankings, 2018/19) and among the oldest in England. King's has more than 31,000 students (including more than 12,800 postgraduates) from some 150 countries worldwide, and some 8,500 staff.
King's has an outstanding reputation for world-class teaching and cutting-edge research. In the 2014 Research Excellence Framework (REF), eighty-four per cent of research at King's was deemed 'world-leading' or 'internationally excellent' (3* and 4*).
Since our foundation, King's students and staff have dedicated themselves in the service of society. King's will continue to focus on world-leading education, research and service, and will have an increasingly proactive role to play in a more interconnected, complex world. Visit our website to find out more about Vision 2029, King's strategic vision for the next 12 years to 2029, which will be the 200th anniversary of the founding of the university.
World-changing ideas. Life-changing impact: https://www.kcl.ac.uk/news/headlines.aspx
About NICE
The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. NICE develops guidance, standards and information on high-quality health and social care. NICE also advises on ways to promote healthy living and prevent ill health.
NICE's aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.
NICE's products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.
To find out more about what NICE does, visit its website: http://www.nice.org.uk and follow it on Twitter, Facebook, LinkedIn and Snapchat.
Journal
The Lancet Child & Adolescent Health