Usefulness of Coupling Transcutaneous Electrical Nerve Stimulation with Routine Physical Therapy in Spinal Spasticity with Intolerant Drug Sideeffects: A Case Report

Abstract

Spasticity is a common complaint in patients with spinal cord injury. Clinically, spasticity is characterized by increased muscle tone, exaggerated tendon reflex, frequent muscle spasm and clonus. We report a case of worsening spasticity in a patient with incomplete cervical spinal cord injury (ASIA B) as a consequence to urinary tract infection. The initial baclofen dose of 5 mg/dose three times per day was increased to 15 mg/dose three times/day with dosage increment at 3-day intervals by 15 mg (5 mg/dose). Marked weakness and vertigo was reported. He continued to suffer from severe spasms and trunk tightness that limited his daily activities and induced intolerable pain. The Modified Ashworth Score was increased from 1+ initially to 3, and the Pen Spasm frequency Score deteriorated from initial 1 to 3. After eradication of urinary tract infection with ciprofloxacin, spasticity did not improve, and so was administered with high-frequency transcutaneous electrical nerve stimulation at the parameters of frequency 100 Hz, pulse-width 0.2 millisecond, intensity 15 mA for the duration of 60 minutes for 3 weeks, coupling with routine physical therapy. After 3 week of TENS therapy, final Modified Ashworth Score reduced to 1+ , and Final Penn Spasm frequency Score was decreased to 2 with much improved quality of life. We also discuss the role of coupling transcutaneous electrical nerve stimulation with physical therapy in spinal spasticity.