Cryoneurolysis for Spasticity in a Pediatric Patient With Cold Urticaria Managed With Targeted Skin Warming: A Case Report.

One child only, so this describes what happened to one person and cannot show that cryoneurolysis works. The primary outcome was safety, not spasticity or gait improvement. The child had physical therapy, bracing, Achilles tendon lengthening, and serial casting before cryoneurolysis, so later range and gait changes cannot be separated from those earlier treatments. Sedation, propofol, ketorolac, dexamethasone, ondansetron, warmed blankets, heated damp cloths, and a catheter barrier were all used at the same time, so the contribution of any single component cannot be separated. Dexamethasone may have reduced a potential cold urticaria reaction, although the authors say it is not standard prophylaxis or first-line treatment for cold urticaria. The patient had no reported angioedema or anaphylaxis, so this does not show safety for severe cold urticaria. Follow-up was only 1 month. The Modified Ashworth Scale was not recorded because the patient could not relax, and passive range testing was difficult because of overstimulation.

P.W. has speaking honoraria and advisory board roles with Pacira, Merz, Ipsen and AbbVie, and his institution received funding for investigator-initiated trials from Pacira and AbbVie. No direct funding was provided for this case report.

Do not conclude that cryoneurolysis safely treats spasticity in cold urticaria. This is one child with mild cold urticaria who also had physical therapy, bracing, Achilles tendon lengthening, serial casting, sedation with propofol, ketorolac, dexamethasone, ondansetron, warmed blankets, heated damp cloths, and a catheter barrier, and the 1-month range and gait changes were observed in a single case report, so the contribution of any single component cannot be separated.