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Efficacy of radial extracorporeal shock wave therapy in hereditary spastic paraplegia: A case report
Akira Shutoh1, Risa Harada1,2, Ryoga Kashima1,2
1Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan.
Rationale:
Hereditary spastic paraplegia (HSP), a rare neurodegenerative disorder in Japan, is characterized by insidiously progressive lower extremity spasticity and muscle weakness. Current management is primarily symptomatic, including physical therapy and spasticity modulation with botulinum toxin or intrathecal baclofen. Recent studies have suggested that extracorporeal shock wave therapy (ESWT) may be effective for treating spasticity in patients recovering from stroke. We report a case exploring the use of radial ESWT (rESWT) combined with physiotherapy in a patient with HSP.
Patient Concerns:
A 31-year-old man diagnosed with HSP in his 20s had been receiving physical therapy and orthotics but experienced progressive bilateral lower extremity spasticity, leading to deterioration in gait function and mobility.
Diagnoses:
Progressive HSP with exacerbated bilateral lower extremity spasticity manifesting as impaired gait efficiency and reduced functional mobility.
Interventions:
The patient was treated with rESWT focusing bilaterally on the calf muscles.
Outcomes:
Posttreatment, the patient's visual analog scale score for ease of walking improved significantly from 40 to 85, reflecting enhanced walking ability. The timed up and go test results improved from 15.08 to 12.59 seconds and 11.51 to 10.43 seconds at comfortable and maximum speeds, respectively. The 10-meter walk test time decreased from 10.48 to 7.24 seconds, and the step count improved from 20 to 14. Despite the modified Ashworth scale scores and dorsiflexion measurements showing minimal changes, no adverse effects were observed.
Lessons:
This case report provides preliminary evidence that rESWT combined with physical therapy may improve gait disturbances, as well as the ease of walking and ambulatory ability, associated with spasticity in HSP. However, due to the limitations of a single-case study and the potential influence of confounding factors, further research - including randomized, placebo-controlled trials - is necessary to confirm its efficacy and determine optimal treatment parameters.
