脳卒中後複雑多因子痙縮に対する双極熱性高周波療法の役割の探求：ボツリヌス毒素A型療法併用症例報告からの臨床的洞察

Post-stroke spasticity significantly impairs quality of life by hindering functional abilities and increasing dependency. Common treatments include botulinum toxin type A (BoNTA) injections. BoNTA is effective for spasticity management, but some situations may require alternative approaches. This case report explores the role and efficacy of bipolar thermal radiofrequency in complex multi-pattern post-stroke spasticity. A 44-year-old man experienced increased left-sided spasticity five years post-stroke, despite initial success with BoNTA. The patient exhibited left hemiparesis with severe spasticity in the left limbs (Modified Ashworth Scale (MAS) score 2 to 4 in several muscle groups) and was treated with high doses of incobotulinumtoxinA. Combined treatment with bipolar thermal radiofrequency was implemented to redistribute the dose among other muscles, achieving a more comprehensive approach for better outcomes. It resulted in immediate spasticity reduction in elbow flexors (MAS 2 to 0). Four weeks post-treatment, the patient reported pain disappearance (visual analogue scale (VAS) 0) and reduced spasticity (MAS 0-3 in several muscle groups). In conclusion, thermal radiofrequency enhances outcomes in post-stroke spasticity, potentially improving functionality and quality of life. As one of the first cases reported, our findings highlight its feasibility and potential benefit. Further research is needed to explore broader applications.