Comparison of the spastic hand treatment methods

Abstract

Background. The main goal of this research is to assess the efficacy of different surgical and conservative methods of spastic hand treatment, and to compare the efficacy of various surgical methods.Methods. 56 patients underwent surgery and 40 received injections of botulotoxin A. Surgery included three methods: selective fasciculotomy of the median and ulnar nerve with or without stimulation of the radial nerve, as well as stereotactic cryodentatectomy. For conservative treatment purposes, botulotoxin A was injected in the muscles of the affected limb in a dose of 10–30 units per 1 kg of a patient’s weight depending on spastisity degree.Results. Selective fasciculotomy with additional temporary stimulation of the radial nerve is the most efficacious approach that helps increase the force and function of the spastic hand. Isolated fasciculotomy and cryodentatectomy decreased spastisity significantly, but did not enhance the force and function of the spastic hand.Conclusions. Botulotoxin A can be used at the initial stage of hand spastisity. In case of relapses surgery should be used to treat of the spastic hand, with selective fasciculotomy with temporary stimulation of the radial nerve being the most efficacious.