**6. Conclusion**

Neurosurgical procedures (ITB, SDR, and DBS) are invasive and costly procedures for the treatment of hypertonia in patients with CP. These modalities are not preferred in the first stage of treatment selection. However, they are considered a second step options for non-responsive patients with CP to other treatments modalities because they improve the major symptoms related to CP. These procedures are accepted as risky but in well-selected cases these modalities could have a real impact on patient's quality of life. High quality randomized controlled clinical trials are necessary to recommend these procedures for selected cases.
