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

Abstract

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.

The short-term effect of ultrasound and peripheral nerve stimulator-guided femoral nerve block with phenol on the outcomes of patients with traumatic spinal cord injury

“…Furthermore, spasticity of these regions prevents patients from benefitting from an efficient therapeutic rehabilitation program. In a systematic review by Lui et al [1], three of the four studies reported a decrease in spasticity after chemical neurolysis with phenol/alcohol. The present study revealed significant improvements in the MAS scores of the hip flexion and knee extension muscles.…”

“…More than 70% of people with spinal cord injury (SCI) have spasticity and it can have a disturbing effect on daily activities such as movement within the home, dressing, bathing, and perineal hygiene [1,2]. In addition, it may interfere with loss of ambulation, joint contractures, pressure ulcers, and pain [3].…”

A review of novel trends in management of canine spinal cord injury

“…Two thirds of humans after SCI complain of pain; about a third of them perceive their pain as severe (Lui et al 2015). It is therefore reasonable to assume the same in dogs (Lorenz et al 2011).…”

“…Recent studies show that the principal cause of spasticity is a lesion of descending tracts resulting in the decreased activity of inhibitory interneurons, leading to excessive reactions of motoneurons to excitatory stimuli (Lewis and Olby 2017). In the management of spasticity, administration of baclofen, diazepam or dantrolene, chemodenervation by botulinum toxin, and laser or pulsed radiofrequency therapy deliver positive results (McIntyre et al 2014;Lui et al 2015;Chang and Cho 2017;Zielinska et al 2017). In spasticity resistant to conservative treatment, the interruption of reflex pathways by selective dorsal rhizotomy or myelotomy is recommended (Enslin and Fieggen 2016).…”

Factors affecting localization and dispersion of alcohol in peripheral nerve block

“…Neuromuscular blockade via injection of alcohol is frequently used to reduce the tone of overactive muscles in clinical practice (10)(11)(12). The effect of a nerve block using alcohol can be influenced by the: volume and concentration of injectate; selection of block site; localization of the target nerve; and dispersion of the injectate (13).…”