{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:59:39Z","timestamp":1787029179448,"version":"build-2736575974"},"reference-count":15,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Clinical Research Program of the Luxembourgish Ministry of Health and Social Security for the spastiCRYO"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurology International"],"abstract":"<jats:p>Background: Chronic post-stroke spasticity often limits gait despite best-practice botulinum-toxin intramuscular injections (BTIs), whose benefit is constrained by short duration, dose ceilings, and tachyphylaxis. Cryoneurolysis (CNL) induces a reversible axonotmesis with preserved endoneurium, potentially providing longer tone reduction with fewer adverse effects, but its impact on whole-gait quality and its compatibility with implanted functional electrical stimulation (FES) remain poorly documented. Case presentation: A 43-year-old man, 12 years after right middle cerebral artery stroke, walked independently with an implanted common peroneal FES system but complained of effortful gait with left-knee \u201clocking\u201d and drop foot without FES. Multiple BTI series to triceps surae and quadriceps yielded only transient benefit. Two ultrasound-guided CNL sessions targeted tibial (soleus, medial gastrocnemius) and femoral (rectus femoris, vastus intermedius) motor branches. Quantitative gait analysis and fine-wire electromyography (EMG) were performed at baseline, 6 weeks after each CNL, and at 6 months, with and without FES. CNL produced immediate and sustained reductions in triceps surae and quadriceps overactivity, resolution of genu recurvatum, normalization of stiff-knee gait, improved ankle dorsiflexion, and increased swing phase knee flexion (&gt;50\u00b0). Gait Deviation Index rose from 69 to 80 and Gillette Gait Index decreased by more than 50%, with preserved strength and without adverse events. Conclusions: Targeted, sequential CNL of tibial and femoral motor branches can safely deliver durable, clinically meaningful gait improvements when BTI has reached its ceiling and can act synergistically with implanted FES. Quantitative gait analysis and EMG sharpen clinical decision-making in spasticity management.<\/jats:p>","DOI":"10.3390\/neurolint18010013","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:46:43Z","timestamp":1767786403000},"page":"13","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Targeted and Sequential Cryoneurolysis Improves Gait After Botulinum-Toxin Unresponsiveness in Post-Stroke Spasticity: A Laboratory-Verified Case"],"prefix":"10.3390","volume":"18","author":[{"given":"Fr\u00e9d\u00e9ric","family":"Chantraine","sequence":"first","affiliation":[{"name":"RehaLAB, Centre National de R\u00e9\u00e9ducation Fonctionnelle et de R\u00e9adaptation\u2014Rehazenter, 1, Rue Andr\u00e9 V\u00e9sale, 2674 Luxembourg, Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Alexandre","family":"Pereira","sequence":"additional","affiliation":[{"name":"RehaLAB, Centre National de R\u00e9\u00e9ducation Fonctionnelle et de R\u00e9adaptation\u2014Rehazenter, 1, Rue Andr\u00e9 V\u00e9sale, 2674 Luxembourg, Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9877-1863","authenticated-orcid":false,"given":"C\u00e9line","family":"Schreiber","sequence":"additional","affiliation":[{"name":"RehaLAB, Centre National de R\u00e9\u00e9ducation Fonctionnelle et de R\u00e9adaptation\u2014Rehazenter, 1, Rue Andr\u00e9 V\u00e9sale, 2674 Luxembourg, Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanja","family":"Classen","sequence":"additional","affiliation":[{"name":"RehaLAB, Centre National de R\u00e9\u00e9ducation Fonctionnelle et de R\u00e9adaptation\u2014Rehazenter, 1, Rue Andr\u00e9 V\u00e9sale, 2674 Luxembourg, Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilles","family":"Areno","sequence":"additional","affiliation":[{"name":"RehaLAB, Centre National de R\u00e9\u00e9ducation Fonctionnelle et de R\u00e9adaptation\u2014Rehazenter, 1, Rue Andr\u00e9 V\u00e9sale, 2674 Luxembourg, Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2061-0968","authenticated-orcid":false,"given":"Fr\u00e9d\u00e9ric","family":"Dierick","sequence":"additional","affiliation":[{"name":"RehaLAB, Centre National de R\u00e9\u00e9ducation Fonctionnelle et de R\u00e9adaptation\u2014Rehazenter, 1, Rue Andr\u00e9 V\u00e9sale, 2674 Luxembourg, Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Suputtitada, A., Chatromyen, S., Chen, C.P.C., and Simpson, D.M. (2024). Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity: A Modified Scoping Review. Toxins, 16.","DOI":"10.3390\/toxins16020098"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1177\/0269215520963855","article-title":"Can the early use of botulinum toxin in post stroke spasticity reduce contracture development? A randomised controlled trial","volume":"35","author":"Lindsay","year":"2021","journal-title":"Clin. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Chen, Y.-T., Zhang, C., Liu, Y., Magat, E., Verduzco-Gutierrez, M., Francisco, G.E., Zhou, P., Zhang, Y., and Li, S. (2020). The Effects of Botulinum Toxin Injections on Spasticity and Motor Performance in Chronic Stroke with Spastic Hemiplegia. Toxins, 12.","DOI":"10.3390\/toxins12080492"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.pmr.2023.06.009","article-title":"Spasticity Treatment Beyond Botulinum Toxins","volume":"35","author":"Li","year":"2024","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1002\/mus.24306","article-title":"Wallerian degeneration and recovery of motor nerves after multiple focused cold therapies","volume":"51","author":"Hsu","year":"2015","journal-title":"Muscle Nerve"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1111\/head.12246","article-title":"The CARE Guidelines: Consensus-Based Clinical Case Reporting Guideline Development","volume":"53","author":"Gagnier","year":"2013","journal-title":"Headache"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Chantraine, F., Filipetti, P., Schreiber, C., Remacle, A., Kolanowski, E., and Moissenet, F. (2016). Proposition of a classification of adult patients with hemiparesis in chronic phase. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0156726"},{"key":"ref_8","unstructured":"Medical Research Council (1976). Aids to the Investigation of the Peripheral Nervous System, Medical Research Council. Memorandum no. 45. Pendragon House."},{"key":"ref_9","first-page":"s23","article-title":"Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with cerebral palsy","volume":"6","author":"Boyd","year":"1999","journal-title":"Eur. J. Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.gaitpost.2010.05.015","article-title":"Gillette Gait Index in adults","volume":"32","author":"Cretual","year":"2010","journal-title":"Gait Posture"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.gaitpost.2008.05.001","article-title":"The gait deviation index: A new comprehensive index of gait pathology","volume":"28","author":"Schwartz","year":"2008","journal-title":"Gait Posture"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Chantraine, F., Schreiber, C., Pereira, J.A.C., Kaps, J., and Dierick, F. (2022). Classification of Stiff-Knee Gait Kinematic Severity after Stroke Using Retrospective k-Means Clustering Algorithm. J. Clin. Med., 11.","DOI":"10.3390\/jcm11216270"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.gaitpost.2006.10.015","article-title":"A time\u2013frequency based electromyographic analysis technique for use in cerebral palsy","volume":"26","author":"Lauer","year":"2007","journal-title":"Gait Posture"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.jelekin.2013.07.002","article-title":"Changes in electromyographic activity after botulinum toxin injection of the rectus femoris in patients with hemiparesis walking with a stiff-knee gait","volume":"23","author":"Boudarham","year":"2013","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"318","DOI":"10.2522\/ptj.20110053","article-title":"The Modified Gait Efficacy Scale: Establishing the Psychometric Properties in Older Adults","volume":"92","author":"Newell","year":"2012","journal-title":"Phys. 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