Pediatric spasticity in Brazil: insights from a neurosurgical referral center

Aim To characterize pediatric spasticity in a Brazilian tertiary center and identify functional demand for neurosurgical interventions.Method Retrospective, cross-sectional study of 161 patients. Functional status was assessed using GMFCS and FMS scales.Results Cerebral palsy (CP) predominated (75.3%), showing high functional severity (43.6% GMFCS V). Median age at referral was 8.5 years. Dystonia was present in 41.1% of the spasticity subgroup. Functional severity did not correlate with age groups (p = 0.266).Interpretation Late referral (median age 8.5 years) contributes to progressive musculoskeletal complications despite stable neurological lesions. Systematic use of GMFCS and FMS provides a reproducible screening tool for surgical candidacy in resource-limited settings. The high prevalence of dystonia (41.1%), characterizing a late-stage mixed hypertonia profile due to delayed referrals, highlights the need for expanded neuromodulation access in public healthcare systems.