Ultrasound-Guided Percutaneous Nerve Stimulation in Post-Stroke Spasticity: A Case Report

Area of Science:

• Neurology
• Rehabilitation Medicine
• Pain Management

Background:

• Post-stroke spasticity (PSS) significantly impairs stroke survivors' quality of life.
• Limited treatment options exist for refractory PSS.
• Ultrasound-guided percutaneous peripheral nerve stimulation (pPNS) is established for pain but unstudied for spasticity.

Purpose of the Study:

• To evaluate the sensorimotor effects of pPNS in a patient with severe PSS.
• To explore pPNS as a potential treatment for refractory spasticity.

Main Methods:

• A 38-year-old male with severe PSS underwent a six-week pPNS protocol (12 sessions).
• Stimulation targeted specific upper limb nerves at low (2 Hz) and medium (10 Hz) frequencies.
• Spasticity assessed via Modified Ashworth Scale (MAS) and Tardieu Scale (TS); somatosensory function evaluated using tactile and pressure pain thresholds, and conditioned pain modulation (CPM).

Main Results:

• Significant reductions in spasticity: 60.4% elbow MAS, 67.0% wrist MAS, 49.5% TS.
• Spasticity returned to baseline between sessions.
• Somatosensory changes included increased tactile thresholds, decreased pressure pain thresholds, and 81.3% CPM reduction.
• pPNS was well-tolerated with minor transient effects; patient preferred it over botulinum toxin.

Conclusions:

• pPNS demonstrated potential for reducing spasticity and modulating somatosensory function in PSS.
• Findings suggest pPNS as a viable alternative for refractory PSS.
• Further research with larger cohorts and control groups is warranted to confirm clinical applicability.