Disclosures: Rebecca Itskevich, DO: No financial relationships or conflicts of interest

Case Diagnosis: 46 yo female with history incomplete C6 SCI, Schatzki’s Ring presenting with rectus abdominis spasticity, 2 years of chronic abdominal pain.

Case Description: Extensive workup by gastroenterology and primary physician was unrevealing. Underwent esophageal sphincter release without benefit. Pain management had twice injected corticosteroid to her right abdominal anterior cutaneous nerve, the first providing 4 months’ relief, the second significantly less. In clinic, patient complained of right-sided abdominal pain unchanged by position, oral intake, or bowel movements. She had allodynia in distribution of the right lateral cutaneous nerve. Her right rectus abdominis was taught, tender to palpation, and confirmed with EMG to be spastic. Focal spasticity occurred in absence of generalized spasticity in other areas of her body. Total of 100 units onabotulinum toxin type A (Botox) was injected into 4 locations (25 units each) of the rectus abdominis using both ultrasound and EMG guidance.

Setting: Outpatient clinic.Assessment/

Results: 5 weeks post-injection of botulinum toxin, patient reported significant improvement of tightness in the region.  She reported excellent spasticity relief improving overall comfort, though her neuropathic pain complaints persisted. After 3 months her spasticity returned.

Discussion: Typically, generalized spasticity is worsened by any noxious stimulus. The unilateral, focal nature of her spasticity makes this case unique. Spasticity (and related discomfort) improved with chemodenervation, but neuropathic pain persisted. Once effects of botulinum toxin wore off, spasticity returned, suggesting neuropathic pain as a contributing factor to the development of focal spasticity. Chemodenervation was an effective treatment of the spasticity component. Previous studies have shown effective relief of neuropathic pain with subcutaneous injections of botulinum toxin to affected areas. This approach may be additionally considered at a future visit.

Conclusion: This is a rare case of very focal spasticity that occurred in conjunction with neuropathic pain in a spinal cord injured patient, where chemodenervation with botulinum toxin was applied successfully.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2021

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/focal-rectus-abdominis-spasticity-and-neuropathic-pain-in-a-spinal-cord-injury-patient-a-case-report/