Boissonnault Ève, MacRae Fraser, Hashemi Mahdis, Bursuc Andrei, Winston Paul
Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
Canadian Advances in Neuro-Orthopedics for Spasticity Consortium, Kingston, Canada.
Arch Rehabil Res Clin Transl. 2024 Jan 5;6(1):100319. doi: 10.1016/j.arrct.2024.100319. eCollection 2024 Mar.
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.
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.
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.
Cryoneurolysis of the femoral nerve may be an effective, long-lasting treatment for spasticity causing stiff knee gait in patients with multiple sclerosis.
膝伸肌痉挛是多发性硬化症患者的常见症状。由此产生的僵硬腿部步态会导致跌倒风险增加、步态期间能量消耗增加、步态速度降低以及增加髋部磨损的代偿性步态机制。冷冻神经lysis是一种针对局灶性痉挛的新型经皮微创治疗方法。
一名多发性硬化症患者接受了股神经分支至股直肌的冷冻神经lysis治疗。对该患者进行了15个月的随访。每次随访时收集痉挛严重程度、步态速度和患者报告的结果。
根据改良Ashworth量表，痉挛严重程度在术后1个月降低，这种变化持续至术后15个月。根据改良Tardieu量表，运动范围在15个月内逐渐改善。术后1个月，10米步行测试的步态速度从21.15秒提高到12.49秒，然后在15个月后减慢至基线水平。患者对其步态的信心有所改善，并且在整个随访期间保持了独立性。由于10米步行测试结果出现倒退，患者选择在15个月后再次接受该治疗。治疗后立即进行10米测试，时间缩短至16.20秒。
股神经冷冻神经lysis可能是治疗多发性硬化症患者因痉挛导致僵硬膝步态的一种有效且持久的治疗方法。
