Treating Refractory Pediatric Spastic Quadriparesis with Alcohol Neurolysis Prior to Neurosurgery: A Case Report

Williams NL1,2*, John-Yung Lin M1 and Nakamura T3

1University of California San Francisco Benioff Children’s Hospital, USA
2Keio University Graduate School of Pharmaceutical Sciences, Japan
3Division of Pharmaceutical Care Sciences, Keio University Graduate School of Pharmaceutical Sciences, Japan

^*Correspondance to: Nathan L Williams 

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Abstract:

Spasticity is a movement disorder caused by impaired sensorimotor function characterized by hyperexcitability of the stretch reflex resulting in involuntary increase of muscle tone. Neuromuscular blockade with alcohol neurolysis has been performed in children to alleviate spasticity although its use is not well standardized. In this case report we detail the successful administration of ethanol neurolysis to alleviate spastic quadriparesis with appropriate clinical response prior to neurosurgery. A 17-year-old male with no significant past medical history presented to the hospital after a traumatic brain injury that resulted in a subdural hematoma. He was admitted emergently to the neurosurgery service for a decompressive craniectomy and subsequent cranioplasty. Over the course of his postoperative care, he continued to experience spastic quadriparesis resulting in worsening pain, self-injury, and infection secondary to interference with medical care. For this reason, it was deemed medically necessary to perform neuromuscular blockade and alcohol neurolysis prior to cranioplasty revision. The target nerves were the bilateral musculocutaneous and obturator nerves. The alcohol neurolysis procedure was carried out using 49.5% ethanol solution. The patient reviewed in this case received the successful application of ethanol neurolysis to alleviate symptoms of spasticity which were deleterious to his quality of life and further complicated his surgical care. The procedure was well tolerated. Further research may prove helpful to delineate the appropriate clinical setting for this procedure as well as optimizing the dose and concentration of the alcohol agent.

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Cite the Article:

Williams NL, John-Yung Lin M, Nakamura T. Treating Refractory Pediatric Spastic Quadriparesis with Alcohol Neurolysis Prior to Neurosurgery: A Case Report. Ann Clin Case Rep. 2024; 9: 2681..