Brief report
Alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle to treat ankle spasticity in patients with hemiplegic stroke

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Abstract

Jang SH, Ahn SH, Park SM, Kim SH, Lee KH, Lee ZI. Alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle to treat ankle spasticity in patients with hemiplegic stroke. Arch Phys Med Rehabil 2004;85:506–8.

Objective

To evaluate the effectiveness of alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle for the treatment of ankle plantarflexor spasticity in patients with hemiplegic stroke.

Design

Case series.

Setting

Inpatient and outpatient clinics in the rehabilitation department of a university hospital.

Participants

Twenty-two patients with hemiplegic stroke (mean age, 48y).

Interventions

Motor branch block (MBB) of the tibial nerve to the gastrocnemius muscle with 50% ethyl alcohol in cases of spastic ankle.

Main outcome measures

The severity of spasticity was assessed using the Modified Ashworth Scale (MAS) score of ankle plantarflexor, clonus score of the ankle, and the passive range of motion (PROM) of ankle dorsiflexion.

Results

The MAS score was reduced in 17 (77%) of 22 patients during the 6-month follow-up, and spasticity reappeared at the level of the pre-MBB state in 5 patients (23%). The mean values of all parameters were significantly improved. The changes of mean values from the pre-MBB to the 6-month post-MBB stage were as follows: MAS score, 3.3±0.7 versus 1.7±1.1; clonus score, 1.6±0.7 versus 0.4±0.8; and PROM, 17.1°±13.0° versus 28.6°±4.7°. No serious complications were observed during the 6-month follow-up period.

Conclusions

MBB of the tibial nerve to the gastrocnemius muscle is an effective and safe procedure for relieving localized spasticity of the ankle plantarflexors.

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.

References (11)

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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.

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