Alcohol neurolysis of the sciatic nerve in the treatment of hemiplegic knee flexor spasticity: clinical outcomes.
OBJECTIVE
To study clinical outcomes after 50% to 100% alcohol neurolysis of the sciatic nerve in the treatment of chronic hemiplegic knee flexor spasticity.


METHODS
Case series using a convenience sample.


METHODS
Rehabilitation teaching hospital.


METHODS
Eight patients (mean age, 55.1 +/- 12.1 yr; mean duration to block, 4.4 +/- 3.7 mo) with chronic hemiplegia and severe spasticity (modified Ashworth scale [MAS] score < 2) secondary to cerebrovascular accidents (n = 5) and traumatic brain injuries (n = 3). Two patients were ambulant, 6 were wheelchair-bound.


METHODS
Fifty percent to 100% alcohol neurolysis of the sciatic nerve using repetitive electric stimulation to localize the sciatic nerve.


METHODS
MAS score, gain in knee range of motion (ROM), and visual inspection of gait at 0, 1, and 6 months postneurolysis. Nonparametric tests were used in statistical analysis.


RESULTS
The mean preinjection MAS score was 2.8 +/- 0.7, which improved to 1.4 +/- 0.7 at 1 month (p = .005), and 1.8 +/- 0.9 (p = .01) and 1.9 +/- 1.1 (p = .02) at 3 and 6 months postinjection, respectively. The mean gain in knee ROM was 34.4 degrees +/- 15.7 degrees at 1 month postinjection and was maintained at 6 months postinjection. Improvements in gait were noted in both ambulant patients, and improved positioning in 3 of 6 wheelchair-bound patients. The incidence of dysesthetic pain was 0%.


CONCLUSIONS
Fifty percent to 100% alcohol neurolysis of the sciatic nerve is a safe and effective method for treatment of hemiplegic knee flexor spasticity, with therapeutic effects lasting 6 months.
Chua
K S
KS
Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Republic of Singapore. karen_chua@notes.ttsh.gov.sg
Kong
K H
KH
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001930:Brain Injuries / Q000150:complications / Q000534:rehabilitation; D000431:Ethanol; D005260:Female; D006429:Hemiplegia / Q000150:complications / Q000534:rehabilitation*; D006801:Humans; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology / Q000534:rehabilitation; D009407:Nerve Block / Q000379:methods*; D012584:Sciatic Nerve; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation
D000431:Ethanol