Practice patterns for spasticity management with phenol neurolysis

Karri, Jay; Mas, Manuel F.; Francisco, Gerard E.; Li, Sheng

doi:10.2340/16501977-2239

Cited by 42 publications

(40 citation statements)

References 26 publications

(40 reference statements)

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Section: Introductionmentioning

confidence: 99%

“…Spasticity is common during the motor recovery phase of persons with various brain or spinal cord injuries (SCIs), and can cause joint contractures, muscle and tendon shortening, and postural deformities. 1,2 These impairments may indirectly prevent these persons from receiving optimal physical rehabilitation, hygiene and nursing care, and orthotic fitting. Consequently, early goal-directed spasticity management in the subacute phase of central neurological injuries is instrumental to facilitate good functional outcomes and limit complications.…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, early goal-directed spasticity management in the subacute phase of central neurological injuries is instrumental to facilitate good functional outcomes and limit complications. [1][2][3][4] Aggressive spasticity management is especially imperative in persons with severe focal spasticity (eg, clenched fist) in the distal upper extremity to optimize early functional recovery in the wrist and fingers. [1][2][3][4][5] Multilevel chemoneurolysis via local injections, which includes chemodenervation with botulinum neurotoxin (BoNT) and phenol neurolysis, is commonly used to treat focal spasticity.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Aggressive spasticity management is especially imperative in persons with severe focal spasticity (eg, clenched fist) in the distal upper extremity to optimize early functional recovery in the wrist and fingers. [1][2][3][4][5] Multilevel chemoneurolysis via local injections, which includes chemodenervation with botulinum neurotoxin (BoNT) and phenol neurolysis, is commonly used to treat focal spasticity. [1][2][3][4][5][6][7] Compared to chemodenervation with BoNT, phenol neurolysis has numerous benefits including producing a faster onset of spasticity relief (within minutes), longer efficacy (up to 6 months), and decreased financial burden.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] Multilevel chemoneurolysis via local injections, which includes chemodenervation with botulinum neurotoxin (BoNT) and phenol neurolysis, is commonly used to treat focal spasticity. [1][2][3][4][5][6][7] Compared to chemodenervation with BoNT, phenol neurolysis has numerous benefits including producing a faster onset of spasticity relief (within minutes), longer efficacy (up to 6 months), and decreased financial burden. 1,2 However, phenol is often avoided largely because of concerns about its safety and efficacy relative to the extensively studied neurotoxins and because it requires a higher level of procedural expertise for effective administration.…”

Section: Introductionmentioning

confidence: 99%

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Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity

Karri

Zhang

2019

PM&R

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Background When managing patients with focal spasticity, phenol neurolysis is often avoided largely because of its presumed poor adverse effect profile. It is suggested that dysesthesias may be more common with phenol neurolysis of the mixed sensorimotor nerves (eg, radial, median, and ulnar nerves) compared to neurolysis of pure motor nerves. However, these risks may be mitigated with precise localization of pure motor branches by ultrasound and electrical stimulation (EStim). Objective To explore practice patterns of phenol neurolysis to distal upper extremity mixed sensorimotor nerves with ultrasound and EStim guidance. Design A retrospective analysis of all neurolysis procedure records at a single institution from January 2013 to February 2018. Demographic and clinical variables including primary neurological diagnosis, concurrent spasticity treatments, nerves injected, phenol dosage and adverse events were abstracted from the electronic medical records. Participants 57 patients who received phenol neurolysis with ultrasound and EStim guidance for spasticity management to radial, median, or ulnar nerves. Main Outcome Measures Reported adverse effects. Results A total of 57 patients who collectively received neurolysis to 139 nerves across 102 encounters, met inclusion criteria. Most prevalent diagnoses included traumatic brain injury (N = 27, 47.4%) and stroke (N = 18, 31.6%), with a smaller subset having spinal cord injury (N = 10, 17.5%). Most patients received concomitant chemodenervation with botulinum toxin (N = 44, 77.2%). The average phenol dosage per nerve was 1.8 mL, with a range of 0.5‐9.0 mL. Reported adverse effects included three cases of prolonged pain, but no dysesthesias were reported during the follow‐up period (>40 days). Conclusions Phenol neurolysis with ultrasound and EStim guidance was successfully and safely used to manage focal spasticity in the distal upper extremity. Level of Evidence III.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity

Karri

Zhang

2019

PM&R

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Complications of Injectable Agents Used Intraoperatively

Szadek

Liebregts

Liem

et al. 2022

Complications of Pain‐Relieving Procedures

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Spasticity Management in Persons with Disorders of Consciousness

Zhang

Karri

O’Brien

et al. 2020

PM&R

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Introduction Spasticity is one of the most frequent neurological impairments affecting persons with disorders of consciousness (DoC). If left untreated, it can mask signs of consciousness by inhibiting one's ability to interact with the environment. The lack of information about spasticity specific to patients with DoC may result in insufficient or even inappropriate treatment. Objective To report spasticity characteristics and management in a large dedicated DoC rehabilitation program. Design Retrospective chart review. Setting An inpatient rehabilitation hospital. Participants Patients admitted to the DoC rehabilitation program from 1 January 2014 to 31 October 2018. Main Outcome Measurements Spasticity characteristics; impact of interventions on spasticity as well as other clinical measures. Results A total of 146 patients were included, of whom 95.2% were affected by spasticity; 52.7% had spasticity affecting all four limbs. The most commonly affected muscle groups were shoulder internal rotators (72.6%) in the upper extremity and ankle plantar flexors (59.8%) in the lower extremity. The more commonly affected muscle groups were also more spastic (R = 0.993 and 0.989 in the upper and lower extremity, respectively; P < .01). Atypical posture patterns were also commonly observed, making positioning difficult. Chemoneurolytic injections (botulinum toxin and/or phenol) were performed in over 69.9% patients, and 26.7% had intrathecal baclofen (ITB) pump placement. All patients received individualized physical modalities and therapies. With focal managements, systemic spasmolytic medications, including enteral baclofen, were reduced by at least 50.0%, which appeared to be associated with improvements in the level of consciousness. Conclusions Almost all DoC patients were affected by spasticity, often to a moderate or severe degree. Extensive use of focal spasticity interventions allowed for weaning of systemic spasmolytic medications, which seemed to result in improvements in the level of consciousness.

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Practice patterns for spasticity management with phenol neurolysis

Cited by 42 publications

References 26 publications

Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity

Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity

Complications of Injectable Agents Used Intraoperatively

Spasticity Management in Persons with Disorders of Consciousness

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