The Changes after Alcohol Neurolysis of the Tibial Nerve Motor Branches to Gastrocnemius Muscles in Poststroke Patients

ABSTRACT

OBJECTIVE: To evaluate the effectiveness and electrophysiological changes after alcohol neurolysis of the tibial nerve motor branches to gastrocnemius muscles on the treatment of ankle spasticity in stroke patients. METHOD: Fourteen poststroke hemiplegic patients who had an abnormal gait pattern due to the ankle spasticity participated. They were evaluated by modified Ashworth scale (MAS) score, passive range of motion (PROM) of ankle, and ankle clonus, and were studied using electrophysiological measurements such as amplitude and latency of H-reflex and M response, and H/M ratio. 50% alcohol was injected into the tibial nerve motor branches to the both gastrocnemius muscles with electromyography guidance. Follow-up evaluations were performed immediately, and then, at the one-week, one-month, and three-months following the neurolysis. RESULTS: The MAS scores significantly decreased and the PROM of the ankle significantly increased. The M response and H-reflex amplitude of gastrocnemius muscles significantly decreased after the neurolysis and they had a tendency to increase at the 3-months follow-up. Also, H/M ratio significantly decreased. There were no serious postinjection complications. CONCLUSION: Alcohol neurolysis of the tibial nerve motor branches was an effective and safe method for the treatment of the ankle spasticity in poststroke hemiplegic patients.