[Interest of anesthetic blocks for assessment of the spastic patient. A series of 815 motor blocks].
BACKGROUND
The purpose of the study was to emphasize the value of anesthetic blocks in the approach to the spastic patient. The report relates our experience concerning 566 patients (ranging in age from 4 to 72 years, mean 48 years) tested by 815 motor blocks performed within a "spasticity and dystonia evaluation" unit. The spasticity was mainly due to stroke (56%), cerebral palsy (21%) and traumatic brain injury (14%).


METHODS
Motor blocks were performed with standardized procedure (specific needle, neurostimulator, localization technique), analytic and functional assessment.


RESULTS
The anesthetic was mostly 1% non-adrenalized etidocaine, chosen for its onset and duration of action. Re-injections were few and side effects exceptional. Quality and motor blocks results were technique-dependent and required patient cooperation. The spasticity disappeared in blocked muscles. Tardieu and Ashworth modified scale showed constantly decreased spasticity (2 to 3 points) with better sensitivity for the Tardieu modified score. Local anesthetic blocks determined the relative contributions of overactivity and of muscle shortening in the generation of the pathologic posture, the muscle or muscles responsible for the spastic pattern and the level of active performance of the antagonistic muscle. New stability was evaluated by functional assessment of gait posture and prehension.


CONCLUSIONS
At the present time, anesthetic motor blocks represent a necessary and decisive stage procedure as regards spastic patient assessment. This method is particularly useful to anticipate a new functional balance and simulate treatment. Motor blocks provide acute knowledge of the pathological pattern and a better adjustment of therapeutic directions.
Filipetti
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Groupe d'Evaluation et de Traitement de la Spasticité et de la Dystonie, Service de Neurochirurgie (Pr Y. Keravel), Hôpital Henri-Mondor, Créteil. arche.medicalpf@voila.fr
Decq
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P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local; D001132:Arm / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000187:drug effects*; D009068:Movement / Q000502:physiology; D009128:Muscle Spasticity / Q000175:diagnosis* / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000503:physiopathology; D009407:Nerve Block / Q000379:methods; D010525:Peripheral Nerves / Q000502:physiology; D012189:Retrospective Studies
D000779:Anesthetics, Local; D008012:Lidocaine