Chemodenervation and Nerve Blocks in the Diagnosis and Management of Spasticity and Muscle Overactivity

Elovic, Elie P.; Esquenazi, Alberto; Alter, Katharine E.; Lin, John; Alfaro, Abraham; Kaelin, Darryl L.

doi:10.1016/j.pmrj.2009.08.001

Cited by 74 publications

(84 citation statements)

References 93 publications

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“…Phenol and alcohol are neurolytic agents which induce chemodenervation [107]. The recommended concentration is 5-7% for phenol and 45-100% for alcohol.…”

Section: Injectable Treatmentsmentioning

confidence: 99%

Spasticity after stroke: Physiology, assessment and treatment

et al. 2013

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Background: Spasticity following a stroke occurs in about 30% of patients. The mechanisms underlying this disorder, however, are not well understood. Method: This review aims to define spasticity, describe hypotheses explaining its development after a stroke, give an overview of related neuroimaging studies as well as a description of the most common scales used to quantify the degree of spasticity and finally explore which treatments are currently being used to treat this disorder. Results: The lack of consensus is highlighted on the basis of spasticity and the associated absence of guidelines for treatment, use of drugs and rehabilitation programmes. Conclusions: Future studies require controlled protocols to determine the efficiency of pharmacological and non-pharmacological treatments for spasticity. Neuroimaging may help predict the occurrence of spasticity and could provide insight into its neurological basis.

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“…Phenol and alcohol are neurolytic agents which induce chemodenervation [107]. The recommended concentration is 5-7% for phenol and 45-100% for alcohol.…”

Section: Injectable Treatmentsmentioning

confidence: 99%

Spasticity after stroke: Physiology, assessment and treatment

et al. 2013

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“…They are less costly options, and are advantageous in their rapid onset and localized potency, but pose possible risks of soft tissue fibrosis development, as well as dysesthesia. 33 Also, alcohol and phenol are difficult to inject, requiring perineural placement, or placement near the point of motor innervation. 23 The effects of phenol are irreversible, and may reduce contraction during voluntary movements, produce scarring, granuloma formation, and edema.…”

Section: Treatment Optionsmentioning

confidence: 99%

“…Injections should be continued on a regular basis at three to four times per year. 33 Unsuccessful trials should lead to pursuing treatments similar to those for generalized spasticity. People commonly encountered in this group include individuals afflicted by stroke and hemiplegic or diplegic cerebral palsy.…”

Section: Treatment Practicesmentioning

confidence: 99%

Optimal management for people with severe spasticity

Shilt¹,

Seibert²,

Kadyan³

2012

DNND

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Spasticity is characterized by velocity-dependent increase in tonic stretch reflexes and tendon jerks. Many people affected by spasticity receive late treatment, or no treatment, which greatly reduces the potential to regain full motor control and restore function. There is much to consider before determining treatment for people with spasticity. Treatment of pediatric patients increases the complexity, because of the substantial difference between adult and pediatric spasticity. Proper patient evaluation, utilization of scales and measures, and obtaining patient and caregiver history is vital in determining optimal spasticity treatment. Further, taking into consideration the limitations and desires of individuals serve as a guide to best management. We have grouped contributing factors into the IDAHO Criteria to elucidate a multidisciplinary approach, which considers a person's complete field of experience. This model is applied to goal setting, and recognizes the importance of a spasticity management team, comprising the treatment subject, his/her family, the environment, and a supportive, well-informed medical staff. The criteria take into account the complexity associated with diagnosing and treating spasticity, with the ultimate goal of improved function.

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“…Commonly used chemodenervation agents include botulinum toxin (BoNT), phenol and alcohol. 10 The utility of phenol has been reported in the literature for over 5 decades, 11 whereas the utility of alcohol and BoNT has been demonstrated more recently.…”

Section: Introductionmentioning

confidence: 99%

Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review

2015

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Study design: Systematic review. Objectives: To systematically review the literature on chemodenervation with botulinum toxin (BoNT) or phenol/alcohol for treatment of limb spasticity following spinal cord injury (SCI). Setting: British Columbia, Canada. Methods: EMBASE, MEDLINE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials were searched for English language studies published up until March 2014. Studies were assessed for eligibility and quality by two independent reviewers. Results: No controlled trials were identified. A total of 19 studies were included: 9 involving BoNT and 10 involving phenol/alcohol. Owing to the clinically diverse nature of the studies, meta-analysis was deemed inappropriate. The studies produced level 4 and level 5 evidence that chemodenervation with BoNT or alcohol/phenol can lead to improvement in outcome measurements classified in the body structure and function, as well as activity domains of the International Classification of Functioning, Disability and Health framework. The Modified Ashworth Scale (MAS) was the most commonly used outcome measure. All six studies on BoNT and three of the four studies on phenol/alcohol measuring MAS reported a decrease in at least one point. An improvement in MAS was not always associated with improvement in function. The effect of phenol/alcohol has the potential to last beyond 6 months; study follow-up did not occur beyond this time point. Conclusion Chemodenervation with BoNT or phenol/alcohol may improve spasticity and function in individuals with SCI. However, there is a lack of high-quality evidence and further research is needed to confirm the efficacy of these interventions.

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Chemodenervation and Nerve Blocks in the Diagnosis and Management of Spasticity and Muscle Overactivity

Cited by 74 publications

References 93 publications

Spasticity after stroke: Physiology, assessment and treatment

Spasticity after stroke: Physiology, assessment and treatment

Optimal management for people with severe spasticity

Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review

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