1301 - A Case Report of Cryoneurolysis with Factor VIII Administration for Cerebral Palsy-Related Spasticity in a Patient with Hemophilia A

Cryoneurolysis is an emerging and minimally-invasive technique that causes secondary axonotmesis of peripheral nerves through the formation of an ice ball and may result in long-lasting improved range of motion and reduced pain in patients with spasticity. The safety of cryoneurolysis has not yet been established in patients with Hemophilia A. Fifteen minutes prior to cryoneurolysis, an IV infusion of 2000 IU of recombinant antihemophilic factor (FVIII) was administered for bleeding prophylaxis. Targets were identified with ultrasound guidance and nerve stimulation and cryoneurolysis was performed without bleeding complications or adverse events. There was an immediate improvement in tone and range of motion that was maintained at 3- and 8-month follow-ups with reported increased left arm function.


Discussions:

This case study highlights the safety and efficacy of cryoneurolysis in a patient with hemophilia A, contrasting it with botulinum toxin (BoNT) treatment. Cryoneurolysis, a minimally invasive, drug-free technique with a low risk of adverse events, such as local infection or swelling, was used successfully with no adverse events. Compared to BoNT, which poses a higher bleeding risk and requires more invasive procedures, cryoneurolysis involves fewer injections, potentially reducing bleeding complications and costs. The patient maintained significant functional improvement and benefits at 8 months. Cryoneurolysis may offer a cost-effective alternative to surgery and BoNT for managing spasticity in hemophilia patients.

Conclusions: This case suggests that cryoneurolysis is an effective, minimally-invasive procedure for spasticity that improves tone and range of motion and is safe for use in patients with Hemophilia A who receive adequate Factor VIII prophylaxis.