Hyperselective Peripheral Neurectomy Versus Medical Therapy for Refractory Poststroke Spasticity: A Randomized...

Area of Science:

• Neurology
• Neurosurgery
• Rehabilitation Medicine

Background:

• Poststroke spasticity is a common, debilitating condition impacting function, independence, and quality of life.
• Current medical treatments for spasticity are often insufficient or temporary.
• Hyperselective peripheral neurectomy presents a potential surgical alternative.

Purpose of the Study:

• To compare the efficacy and safety of hyperselective peripheral neurectomy versus best medical therapy for poststroke spasticity.
• To evaluate the impact on spasticity severity, functional independence, and safety outcomes.

Main Methods:

• A prospective, randomized controlled trial involving adults with severe poststroke spasticity (Modified Ashworth Scale [MAS] score 3-4) refractory to baclofen.
• Patients were randomized to either surgery plus rehabilitation or continued medical therapy with rehabilitation.
• The primary outcome was the change in MAS score at 12 months post-intervention.

Main Results:

• The surgical group demonstrated a significantly greater reduction in spasticity (1.36 points difference; P < .001) compared to the medical group at 12 months.
• 96% of patients in the surgical group achieved a clinically meaningful improvement (≥1-grade) in MAS score versus 8% in the medical group.
• Functional independence improved in the surgical group, with no significant differences in power or sensory outcomes; transient neuropathic pain occurred in 5 surgical patients.

Conclusions:

• Hyperselective peripheral neurectomy provides substantial and sustained reduction in poststroke spasticity.
• This surgical intervention is effective in carefully selected patients experiencing refractory spasticity.
• The procedure shows promise for improving functional outcomes in poststroke spasticity management.