Neurochirurgie
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Peripheral nerve blockade is one of the therapeutic options for spasticity of various muscles. Percutaneous nerve stimulation allows accurate location of nerves and neurolysis can be performed using intraneural injection of 65% ethanol or 5 to 12% phenol. Spastic contraction of various muscle groups is a common source of pain and disability which prevents efficient rehabilitation. ⋯ No complications occur and minor side effects are transient painful phenomena during injection. These approaches have proved to be accurate, fast, simple, highly successful and reproducible. Percutaneous neurolytic procedures, should be performed as early as possible, as soon as spasticity becomes painful and disabling in patients with neurological sequelae of stroke, head trauma or any lesion of the motor neurons.
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Intrathecally delivered baclofen has been used as a treatment for severe spasticity since 1984. A systematic literature review was conducted from 1984 to December 2002 to analyze the results of this treatment and to collect data on complications. Studies were included if the following criteria were met: clear selection of patients suffering from spasticity of spinal or cerebral origin, clear measurements of outcome (Ashworth score, Spasm score and/or reflex score and/or functional scales), average follow-up of at least 6 months. ⋯ Complications were rather rare and mainly were not life-threatening, although there was a high rate of catheter dysfunction (10 to 45%) leading to reoperation. Wound complications were the leading cause of explantation in children with cerebral palsy. Despite the risks, patient satisfaction was high and was related to the improvement of the quality of life.