Managing severe lower limb spasticity in multiple sclerosis: does intrathecal phenol have a role?

Area of Science:

• Neurology
• Rehabilitation Medicine
• Pain Management

Background:

• Severe lower limb spasticity and pain in advanced multiple sclerosis (MS) present significant management challenges.
• Established treatments often have limited efficacy, leading to renewed interest in alternative therapies like lumbar intrathecal phenol injection (IP).

Purpose of the Study:

• To evaluate the authors' clinical experience and outcomes of using lumbar intrathecal phenol injection (IP) for severe lower limb spasticity in patients with advanced MS.

Main Methods:

• An observational, cross-sectional study involving 25 patients with progressive MS undergoing IP for severe lower limb spasticity.
• Prospective data collection included Ashworth scale, spasm frequency, pain scores, and goal achievement before and after initial or serial IP treatments.

Main Results:

• All patients experienced reduced lower limb tone bilaterally post-injection.
• Significant improvement in tone was noted on the targeted side after initial IP (p=0.003), with no difference after serial injections (p=0.731).
• Improvements in positioning, spasm reduction, pain relief, and carer assistance were reported by a majority of patients.

Conclusions:

• Lumbar intrathecal phenol injection (IP) is an effective treatment for reducing lower limb tone, spasms, and pain in severe MS.
• The procedure enhances patient comfort and facilitates care, although careful patient selection is crucial for optimal outcomes.