STEP 2: Spasticity Live Course - April 25-26, 2025, in Rosemont, IL-Diplegic Cerebral Palsy Leading to Lower Extremity Neurolysis

Pdf Summary

This document outlines the applications and procedures in interventional spasticity management, focusing largely on the use of neurolytic techniques like chemical injections, radiofrequency, cryoneurolysis, and surgical methods to disrupt nerve signal transmissions. Specifically, it highlights the use of phenol and ethanol in neurolysis, which involves mixed indications and procedures for managing spasticity, primarily by targeting peripheral nerves and motor points.<br /><br />Phenol, historically used since the 1800s, acts by denaturing proteins, leading to non-selective nerve destruction and tissue necrosis. Its clinical use involves typically a 5-7% aqueous solution, with benefits lasting 3-9 months. The document underscores phenol's role in conditions needing large muscle treatment, resistance to botulinum toxin, multiple limb involvement, or distribution of neurotoxin elsewhere.<br /><br />Ethanol is another neurolytic agent, available up to 100% concentration but typically used in 45-100% for clinical procedures. It is metabolized differently, requiring larger volumes due to its spread characteristics.<br /><br />The use of these agents can supplement or replace neurotoxins, allowing broader distribution or alternative uses such as managing symptoms like sialorrhea and headaches. Neurolysis is employed in various nerves, like spinal accessory, pectoral, obturator, and motor points to different muscles.<br /><br />Risks and adverse effects of these procedures include dysesthesias, injection site pain, muscle discomfort, and severe complications like cardiac toxicity or seizures. The document also discusses the importance of proper injection techniques, using e-stimulation and ultrasound guidance to enhance accuracy and outcomes, and stresses post-procedure measures like avoiding aggressive stretching.<br /><br />Finally, future directions in the field are highlighted, including cryoneurolysis trials and potential use of computerized tomography for identifying motor branches more precisely, along with supplemental therapies like splinting and serial casting for comprehensive spasticity management.

Asset Subtitle

Daniel K Moon, MD

Keywords

interventional spasticity management

neurolytic techniques

chemical injections

phenol

ethanol

neurolysis

nerve signal disruption

cryoneurolysis

ultrasound guidance

spasticity management