Hyperselective Peripheral Neurectomy Versus Medical Therapy for Refractory Poststroke Spasticity: A Randomized Controlled Trial
Jitin Bajaj, Lalit Kumar Banawal, Anivesh Jain, Namrata Khandelwal, Amit Kumar, Jayant Patidar, Chris Leslie Lemos, Ritika Dhurwe, Meena Singh, Mallika Sinha, Mukesh Sharma, Shailendra Ratre, Vijay S. Parihar, Narayan M. Swamy, Yad R. YadavBACKGROUND AND OBJECTIVES:
Poststroke spasticity is a common and debilitating condition that limits functions, is associated with pain, and impairs independence. Medications are often costly, temporary or insufficient to manage this condition. We aimed to compare the efficacy and safety of hyperselective peripheral neurectomy with best medical therapy in patients of poststroke spasticity.
METHODS:
This trial was a prospective, randomized controlled study performed on adults with poststroke spasticity [modified Ashworth scale (MAS) score of 3-4] refractory to maximal tolerated baclofen. Patients were randomized (1:1) to undergo surgery plus rehabilitation or to continue medical therapy with rehabilitation. The primary outcome was change in MAS score at 12 months from baseline.
RESULTS:
Fifty patients were randomized equally into the 2 groups. At 12 months, the surgical group had significantly greater reduction in spasticity with a between-group difference of 1.36 points (95% CI 0.97-1.74;
CONCLUSION:
The hyperselective peripheral neurectomy is associated with substantial and sustained reduction in spasticity in carefully selected patients.
TRIAL REGISTRATION NUMBER:
CTRI/2023/11/060191.