Successful intrathecal ethanol block for intractable spasticity of AIDS-related progressive multifocal leukoencephalopathy

Objective: To study the efficacy of intrathecal ethanol block to: relieve i ntractable spasticity in AIDS-related progressive multifocal leukoencephalo pathy (PML) when long-term intrathecal baclofen infusion cannot be used. Methods: A 33-year-old man with AIDS-related PML developed very severe spas tic paraparesis (Ashworth rigidity score, 4) and painful muscle spasms. The patient was unable to sit in his wheelchair and remained bed bound. Combin ed oral baclofen and tizanidine at therapeutical doses were used without an y effect on the spasticity. The patient refused the placement of an intrath ecal catheter for long-term baclofen infusion. A single intrathecal ethanol (6 ml) injection in the L2-L3 intervertebral space with the patient placed in a lateral Trendelenburg (40 degrees C) position was performed. Results: The procedure was very effective in improving the stiffness (Ashwo rth rigidity score, 2, after the technique) and the muscle spasms disappear ed. No side effects during or after the injection were observed. Conclusion: Intrathecal ethanol block is a last but very useful choice for treatment of intractable spasticity in PML and other neurologic disorders i n AIDS patients when other oral treatments have failed and intrathecal bacl ofen infusion is not suitable.