title: Managing severe lower limb spasticity in multiple sclerosis: does intrathecal phenol have a role?
abstract: OBJECTIVE
  Established treatment options for managing severe lower limb spasticity and associated pain are of limited value in people with advanced multiple sclerosis (MS). This has resulted in a resurgence of the use of lumbar intrathecal phenol injection (IP). The aim of this study was to investigate the authors' experience with IP.
  
  
  METHODS
  This observational study collected cross sectional data from patients with progressive MS who received IP for severe lower limb spasticity. Data from 25 patients were collected prospectively before and after treatment. In 15 cases the data related to the first treatment and in 10 to serial injections. Outcome measures collected included the Ashworth scale, a spasm frequency scale, a pain rating score, and the percentage achievement of practical goals.
  
  
  RESULTS
  After injection, all patients demonstrated reduced lower limb tone bilaterally. After the initial injection there was significant improvement on the targeted as compared with the non-targeted side (Wilcoxon rank p=0.003), while no difference in the degree of improvement between the targeted and non-targeted side was seen after serial injections (Wilcoxon rank p=0.731). Twenty four patients were easier to position and 21 had a reduction in their spasm frequency and intensity. Eleven patients with pain reported benefit. Carers found washing and dressing easier in 16 patients and improved safety when using the hoist in 10. Six patients had recurrence of skin breakdown and five patients reported transient adverse changes in their bowel function.
  
  
  CONCLUSIONS
  IP can reduce lower limb tone bilaterally after both initial and serial injections. This is most noticeable on the targeted side after initial injection. IP can reduce spasms and pain, leading to improvements in care and overall comfort. IP is an effective treatment option in the management of severe spasticity. Documented selection criteria are essential.
authors.affiliation: National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Jarrett
authors.forename: P
authors.initials: P
authors.lastname: Nandi
authors.forename: A J
authors.initials: AJ
authors.lastname: Thompson
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000188:drug therapy*; D009128:Muscle Spasticity / Q000188:drug therapy*; D010147:Pain Measurement; D019800:Phenol / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D019800:Phenol