Alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle to treat ankle spasticity in patients with hemiplegic stroke

Objective: To evaluate the effectiveness of alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle for the treatment of ankle plantarflexor spasticity in patients with hemiplegic stroke. Design: Case series. Setting: Inpatient and outpatient clinics in the rehabilitation department of a university hospital. Participants: Twenty-two patients with hemiplegic stroke (mean age, 48y). Interventions: Motor branch block (MBB) of the tibial nerve to the gastrocnemius muscle with 50% ethyl alcohol in cases of spastic ankle. Main Outcome Measures: The severity of spasticity was assessed using the Modified Ashworth Scale (MAS) score of ankle plantarflexor, clonus score of the ankle, and the passive range of motion (PROM) of ankle dorsiflexion. Results: The MAS score was reduced in 17 (77%) of 22 patients during the 6-month follow-up, and spasticity reappeared at the level of the pre-MBB state in 5 patients (23%). The mean values of all parameters were significantly improved. The changes of mean values from the pre-MBB to the 6-month post-MBB stage were as follows: MAS score, 3.3 +/- 0.7 versus 1.7 +/- 1.1; clonus score, 1.6 +/- 0.7 versus 0.4 +/- 0.8; and PROM, 17.1degrees +/- 13.0degrees versus 28.6degrees +/- 4.7degrees. No serious complications were observed during the 6-month follow-up period. Conclusions: MBB of the tibial nerve to the gastrocnemius muscle is an effective and safe procedure for relieving localized spasticity of the ankle plantarflexors.