Brief reportAlcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle to treat ankle spasticity in patients with hemiplegic stroke☆
Section snippets
Participants
Twenty-two patients with hemiplegic stroke (17 men; mean age, 48y; range, 21–80y; 10 with infarcts) were selected according to the following criteria: (1) severe ankle plantarflexor spasticity in the knee extension state (Modified Ashworth Scale4 [MAS] score, ≥2) and (2) limitations on walking or standing due to ankle plantarflexor spasticity. The exclusion criteria were: (1) deep vein thrombosis of the affected lower extremity and (2) a history of adverse reactions to alcohol. The mean
Results
The MAS score for the ankle plantarflexor was reduced in all 22 patients immediately after MBB (table 1), and this was maintained over the 6-month follow-up period in 17 patients (77%). However, the pre-MBB level of spasticity reappeared in 5 patients (23%); at 1 month after MBB, it reappeared in 4 of the 5; and at 3 months after MBB it reappeared in 1 patient. The mean MAS score for pre-MBB was 3.3±0.7, and this improved to 0.6±0.6 immediately after MBB and to 1.2±1.1 at 1 month, 1.6±1.1 at 3
Discussion
Several studies7, 8 have shown the safety and the effectiveness of alcohol neurolysis of the peripheral nerves. Alcohol works by denaturing proteins, resulting in the splitting of myelin sheaths. The nerve, subsequently, undergoes Wallerian degeneration.9 Although several studies involved blocking the main trunk of the tibial nerve,10, 11 this procedure has not become popular because of frequent neuropathic pain and nonselectivity. Garland et al2 and Moore and Anderson3 reported on phenol block
Conclusions
We believe that MBB of the tibial nerve to the gastrocnemius muscle, using 50% ethyl alcohol, is a safe and effective procedure for reducing ankle plantarflexor spasticity in stroke patients and that this technique offers benefits that last at least 6 months.
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Supported by the Neuroscience Association of Yeungnam University Medical Center.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated.