1406 - Multisite treatment with percutaneous cryoneurolysis for hemiplegia in long standing refractory post stroke spasticity.

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

Romain David, MD

Physiatrist
University of Poitiers
Quinçay, Poitou-Charentes, France

Co-Author(s)

MH

Mahdis Hashemi, MD

Physiatrist
Vancouver island health
Victoria BC, British Columbia, Canada
Paul J. Winston, MD

Clinical Associate Professor
Vancouver Island Health Authority; The University of British Columbia, Faculty of Medicine
Victoria, British Columbia, Canada

Case Diagnosis:
Spasticity is common after stroke. Though termed focal spasticity, it is typically located at multiple sites. Spastic hemiplegia severely impairs functional capability and mobility, impacting daily life activities and social participation. Percutaneous cryoneurolysis is a novel mini-invasive, treatment that may be beneficial to improve outcomes for multisite focal muscle spasticity.

Case Description:
A non-ambulatory patient, twelve years post stroke, with severe spasticity who was treated with 400-units of onabotulinum toxin every three months was referred for his spasticity that had plateaued with treatment. Diagnostic nerve blocks with 2% lidocaine were performed to select the most responsible muscles contributed to the spastic positioning. He was later treated by with ultrasound and e-stimulation guided percutaneous cryoneurolysis to: thoracodorsal nerve, intramuscular subscapularis nerve, medial and lateral pectoralis nerves, musculocutaneous nerve branches to biceps brachii and, brachialis, median nerve trunk above the elbow and tibial nerve trunk. There are no side effects reported by the patient.

Discussions:
The patient demonstrated immediate improvement in flexibility, reduced spasticity, and increased range of motion in his shoulder, elbow, wrist, fingers and ankle. This result improved at 2 follow-ups for spasticity (MAS 3 at baseline to 1+ at follow-ups) and joint amplitudes (shoulder flexion 85° to 110°; shoulder abduction 85° to 130°, elbow extension -50° to -30°; wrist extension 25° to 60°, ankle dorsiflexion -40° to 0°). He also noted a functional improvement in his ability to abduct his shoulder, flex and extend his elbow and ankle dorsiflexion. The patient reported that he had not previously received increased range of motion with treatments with botulinum toxin, bracing and physical therapies.

Conclusions:
Cryoneurolysis for multisite treatment of focal spasticity resulted in improved range of motion and reduced spasticity after plateauing on prior treatments.