224 - Cryoneurolysis for Focal Spasticity in Neuromyelitis Optica: Sustained Functional Gains Across Two Treatment Cycles

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

SY

Sera Yoo, MD

Resident, PGY-2
Yale New Haven Hospital
New Haven, Connecticut, United States

Co-Author(s)

AP

Avish S. Persaud, MD

Resident doctor
Yale New Haven Health
Rochester Hills, Michigan, United States
MD

Mustafa R. Dodurgali, MD

Resident Physician
Yale School of Medicine
New Haven, Connecticut, United States
JH

Jennifer Hankenson, DO

Assistant Professor of Orthopaedics & Rehabilitation
Yale New Haven Hospital
New Haven, Connecticut, United States

Submitter(s)

SY

Sera Yoo, MD

Resident, PGY-2
Yale New Haven Hospital
New Haven, Connecticut, United States

Case Diagnosis: A 57-year-old female with neuromyelitis optica presented with chronic upper and lower limb spasticity, partially responsive to botulinum toxin injections. She underwent two cryoneurolysis procedures targeting musculocutaneous, pectoral, and tibial nerves to address spasticity and improve functional mobility.

Case Description: The first cryoneurolysis targeted upper limbs, yielding marked improvement in elbow extension and hand opening. Range of motion gains persisted for approximately six months before gradual return of spasticity. A second treatment, which was 10 months after the first treatment, expanded targets to both upper and lower extremities, with immediate gains in limb mobility and better performance in activities of daily living. Both procedures were ultrasound-guided, without complications.

Discussions: Cryoneurolysis produces a controlled, reversible axonotmesis, interrupting motor nerve conduction for months until regeneration occurs. Consistent benefit duration (~6 months) aligns with emerging literature on nerve regrowth timelines. We selected cryoneurolysis after suboptimal response to botulinum toxin and to avoid phenol/alcohol neurolysis, which has less predictable spread and a higher risk of dysesthesia. Advantages include long-lasting effect, muscle preservation, and reduced treatment frequency, potentially improving functional outcomes. Cryoneurolysis can be repeated without apparent attenuation of benefit and may complement chemodenervation (e.g., botulinum toxin), although confirmatory data are limited. The safety profile is generally favorable; reported adverse effects include transient dysesthesia, local swelling, or ecchymosis—none occurred here. Evidence specific to neuromyelitis optica spectrum disorder remains sparse, but early experience across focal spasticity etiologies supports feasibility and nerve selectivity. Prospective comparative studies are needed to refine candidate/target selection and quantify durability in NMOSD.

Conclusions: In persistent focal spasticity, cryoneurolysis can provide substantial, durable improvements in range of motion and function, lasting approximately six months. Precise nerve targeting and integration with other modalities, such as botulinum toxin, may optimize outcomes. This case supports cryoneurolysis as an effective, minimally invasive tool in the multidisciplinary management of complex spasticity.