The Effect of Percutaneous Selective Radiofrequency Thermocoagulation in the Treatment of Spasticity with Cerebral Palsy

OBJECTIVE: To compare the therapeutic effects between radiofrequency thermocoagulation and phenol motor branch block in treatment of spasticity of child with cerebral palsy. METHOD: Thirteen patients with spastic cerebral palsy were randomly divided into two groups. One group received percutaneous selective radiofrequency thermocoagulation on tibial nerve motor branch and the other group received phenol motor branch block to the gastrocnemius muscle. Therapeutic effects were assessed before and after treatment for 6 months in each group. The severity of ankle spasticity was assessed with the modified Ashworth scale (MAS), the modified Tardieu scale (MTS), and the passive range of motion (PROM) of ankle joint. RESULTS: In both groups, the MAS and MTS decreased, and radiofrequency thermocoagulation group showed more significant reduction of the spasticity (p<0.05). There was a significant increase in PROM on knee flexion and extension in a radiofrequency thermocoagulation group (p<0.05). CONCLUSION: Percutaneous selective radiofrequency thermocoagulation could be a treatment option for relieving the localized spasticity of ankle in spastic cerebral palsy with little adverse effect.

Ultrasonographic Findings of Mild and Very Mild Carpal Tunnel Syndrome

OBJECTIVE: To assess the clinical usefulness of ultrasonography for the diagnosis of mild and very mild carpal tunnel syndrome. METHOD: Ultrasonographic evaluation was performed in 39 hands of 29 patients with mild and very mild carpal tunnel syndrome according to Bland's neurophysiologic grading scale. Controls included 41 hands of 34 subjects without electrophysiologic evidence of carpal tunnel syndrome. Ultrasonographic findings were evaluated quantitatively with regard to the cross-sectional area, the flattening ratio, the swelling ratio of the median nerve, and palmar displacement of the flexor retinaculum. The analysis of differences between controls and patients group were done by independent t-test. Cut-off values using receiver operation characteristic, were calculated. RESULTS: Patients had significantly increased cross sectional area and flattening ratio of the median nerve at proximal carpal area, palmar displacement of the flexor retinaculum at proximal carpal area. A critical value of equal or higher to 8.5 mm(2) for cross-sectional area at the pisiform level showed a sensitivity 79.5%, a specificity of 95.1%, which had most diagnostic value compared with the value of cross-sectional area at the distal radius level, flattening ratio at the pisiform level and palmar displacement. CONCLUSION: Ultrasonography was useful in the diagnosis of mild and very mild carpal tunnel syndrome.

Percutaneous Selective Radiofrequency Thermocoagulation in the Treatment of Spastic Cerebral Palsy: A case report

Cerebral palsy is the most common motor disorder in childhood. In cerebral palsy, spasticity can be a very disabling feature: limited locomotor abilities, contracture and gait difficulty. We present two cases of cerebral palsy patients who had treated with oral medication and chemodenervation with the Botulinum toxin A or alcohol but could not walk independently. We performed percutaneous selective radiofrequency thermocoagulation in the tibial motor nerve branch under the general anesthesia. The degree of spasticity, which was measured with modified Ashworth scale and modified Tardieu scale, was reduced and recurrence of the spasticity wasn't seen untill 6 months. Percutaneous selective radiofrequency thermocoagulation could be a treatment option for spasticity of cerebral palsy with little adverse effect.