Cryoneurolysis of the Femoral Nerve for Focal Spasticity in an Ambulatory Patient
Introduction: Spasticity of the knee extensors is a common presentation among patients with multiple sclerosis. The resulting stiff leg gait can result in increased risk of falls, heightened energy expenditure during gait, lowered gait speed, and compensatory gait mechanisms that increase wear on th...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | Archives of Rehabilitation Research and Clinical Translation |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590109524000028 |
| _version_ | 1797287584669368320 |
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| author | Ève Boissonnault, MD Fraser MacRae, BSc Mahdis Hashemi, MD Andrei Bursuc, MD Paul Winston, MD |
| author_facet | Ève Boissonnault, MD Fraser MacRae, BSc Mahdis Hashemi, MD Andrei Bursuc, MD Paul Winston, MD |
| author_sort | Ève Boissonnault, MD |
| collection | DOAJ |
| description | Introduction: Spasticity of the knee extensors is a common presentation among patients with multiple sclerosis. The resulting stiff leg gait can result in increased risk of falls, heightened energy expenditure during gait, lowered gait speed, and compensatory gait mechanisms that increase wear on the hips. Cryoneurolysis is a novel percutaneous, minimally invasive treatment for focal spasticity. Methods: A single patient with multiple sclerosis was treated with cryoneurolysis of the femoral nerve branch to rectus femoris. The patient was followed for 15 months. Spasticity severity, gait speed, and patient reported outcomes were collected at each follow-up. Results: Spasticity severity as per the Modified Ashworth Scale was reduced at 1 month, with change persisting up to 15 months post-procedure. Range of motion as per the Modified Tardieu Scale showed gradual improvement over the 15-month period. Gait speed increased after the procedure from 21.15 seconds to 12.49 seconds for the 10 m walk test 1 month post-procedure, then slowed to baseline after 15 months. The patient's confidence in their gait improved and their independence was maintained throughout the follow-up period. Because of the regression in the 10 m walk test, the patient elected to have the procedure repeated after 15 months. Immediately after the procedure, the 10 m test time improved to 16.20 seconds. Conclusion: Cryoneurolysis of the femoral nerve may be an effective, long-lasting treatment for spasticity causing stiff knee gait in patients with multiple sclerosis. |
| first_indexed | 2024-03-07T18:36:23Z |
| format | Article |
| id | doaj.art-983f4371156947c2bc5e90ac0a42375d |
| institution | Directory Open Access Journal |
| issn | 2590-1095 |
| language | English |
| last_indexed | 2024-03-07T18:36:23Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Archives of Rehabilitation Research and Clinical Translation |
| spelling | doaj.art-983f4371156947c2bc5e90ac0a42375d2024-03-02T04:54:45ZengElsevierArchives of Rehabilitation Research and Clinical Translation2590-10952024-03-0161100319Cryoneurolysis of the Femoral Nerve for Focal Spasticity in an Ambulatory PatientÈve Boissonnault, MD0Fraser MacRae, BSc1Mahdis Hashemi, MD2Andrei Bursuc, MD3Paul Winston, MD4Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Canadian Advances in Neuro-Orthopedics for Spasticity Consortium, Kingston, CanadaCanadian Advances in Neuro-Orthopedics for Spasticity Consortium, Kingston, Canada; Vancouver Island Health Authority, Victoria, Canada; Western University, London, CanadaCanadian Advances in Neuro-Orthopedics for Spasticity Consortium, Kingston, Canada; Vancouver Island Health Authority, Victoria, CanadaCentre Hospitalier de l'Université de Montréal, Montréal, CanadaCanadian Advances in Neuro-Orthopedics for Spasticity Consortium, Kingston, Canada; Vancouver Island Health Authority, Victoria, Canada; University of British Columbia, Vancouver, Canada; Corresponding author Paul Winston, 1 Hospital Way, Victoria, BC, Canada V8Z 6R5.Introduction: Spasticity of the knee extensors is a common presentation among patients with multiple sclerosis. The resulting stiff leg gait can result in increased risk of falls, heightened energy expenditure during gait, lowered gait speed, and compensatory gait mechanisms that increase wear on the hips. Cryoneurolysis is a novel percutaneous, minimally invasive treatment for focal spasticity. Methods: A single patient with multiple sclerosis was treated with cryoneurolysis of the femoral nerve branch to rectus femoris. The patient was followed for 15 months. Spasticity severity, gait speed, and patient reported outcomes were collected at each follow-up. Results: Spasticity severity as per the Modified Ashworth Scale was reduced at 1 month, with change persisting up to 15 months post-procedure. Range of motion as per the Modified Tardieu Scale showed gradual improvement over the 15-month period. Gait speed increased after the procedure from 21.15 seconds to 12.49 seconds for the 10 m walk test 1 month post-procedure, then slowed to baseline after 15 months. The patient's confidence in their gait improved and their independence was maintained throughout the follow-up period. Because of the regression in the 10 m walk test, the patient elected to have the procedure repeated after 15 months. Immediately after the procedure, the 10 m test time improved to 16.20 seconds. Conclusion: Cryoneurolysis of the femoral nerve may be an effective, long-lasting treatment for spasticity causing stiff knee gait in patients with multiple sclerosis.http://www.sciencedirect.com/science/article/pii/S2590109524000028GaitMultiple sclerosisRehabilitationSpasticity |
| spellingShingle | Ève Boissonnault, MD Fraser MacRae, BSc Mahdis Hashemi, MD Andrei Bursuc, MD Paul Winston, MD Cryoneurolysis of the Femoral Nerve for Focal Spasticity in an Ambulatory Patient Archives of Rehabilitation Research and Clinical Translation Gait Multiple sclerosis Rehabilitation Spasticity |
| title | Cryoneurolysis of the Femoral Nerve for Focal Spasticity in an Ambulatory Patient |
| title_full | Cryoneurolysis of the Femoral Nerve for Focal Spasticity in an Ambulatory Patient |
| title_fullStr | Cryoneurolysis of the Femoral Nerve for Focal Spasticity in an Ambulatory Patient |
| title_full_unstemmed | Cryoneurolysis of the Femoral Nerve for Focal Spasticity in an Ambulatory Patient |
| title_short | Cryoneurolysis of the Femoral Nerve for Focal Spasticity in an Ambulatory Patient |
| title_sort | cryoneurolysis of the femoral nerve for focal spasticity in an ambulatory patient |
| topic | Gait Multiple sclerosis Rehabilitation Spasticity |
| url | http://www.sciencedirect.com/science/article/pii/S2590109524000028 |
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