A Retrospective Review of Unintended Effects After Single‐Event Multi‐Level Chemoneurolysis With Botulinum Toxin‐A and Phenol in Children With Cerebral Palsy

Ploypetch, Teerada; Kwon, Jeong-Yi; Armstrong, Hilary F.; Kim, Heakyung

doi:10.1016/j.pmrj.2015.05.020

Cited by 19 publications

(16 citation statements)

References 25 publications

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“…[1][2][3][4][5] Multilevel chemoneurolysis via local injections, which includes chemodenervation with botulinum neurotoxin (BoNT) and phenol neurolysis, is commonly used to treat focal spasticity. [1][2][3][4][5][6][7] Compared to chemodenervation with BoNT, phenol neurolysis has numerous benefits including producing a faster onset of spasticity relief (within minutes), longer efficacy (up to 6 months), and decreased financial burden. 1,2 However, phenol is often avoided largely because of concerns about its safety and efficacy relative to the extensively studied neurotoxins and because it requires a higher level of procedural expertise for effective administration.…”

Section: Introductionmentioning

confidence: 99%

“…Multilevel chemoneurolysis via local injections, which includes chemodenervation with botulinum neurotoxin (BoNT) and phenol neurolysis, is commonly used to treat focal spasticity . Compared to chemodenervation with BoNT, phenol neurolysis has numerous benefits including producing a faster onset of spasticity relief (within minutes), longer efficacy (up to 6 months), and decreased financial burden .…”

Section: Introductionmentioning

confidence: 99%

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Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity

Karri

Zhang

2019

PM&R

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Background When managing patients with focal spasticity, phenol neurolysis is often avoided largely because of its presumed poor adverse effect profile. It is suggested that dysesthesias may be more common with phenol neurolysis of the mixed sensorimotor nerves (eg, radial, median, and ulnar nerves) compared to neurolysis of pure motor nerves. However, these risks may be mitigated with precise localization of pure motor branches by ultrasound and electrical stimulation (EStim). Objective To explore practice patterns of phenol neurolysis to distal upper extremity mixed sensorimotor nerves with ultrasound and EStim guidance. Design A retrospective analysis of all neurolysis procedure records at a single institution from January 2013 to February 2018. Demographic and clinical variables including primary neurological diagnosis, concurrent spasticity treatments, nerves injected, phenol dosage and adverse events were abstracted from the electronic medical records. Participants 57 patients who received phenol neurolysis with ultrasound and EStim guidance for spasticity management to radial, median, or ulnar nerves. Main Outcome Measures Reported adverse effects. Results A total of 57 patients who collectively received neurolysis to 139 nerves across 102 encounters, met inclusion criteria. Most prevalent diagnoses included traumatic brain injury (N = 27, 47.4%) and stroke (N = 18, 31.6%), with a smaller subset having spinal cord injury (N = 10, 17.5%). Most patients received concomitant chemodenervation with botulinum toxin (N = 44, 77.2%). The average phenol dosage per nerve was 1.8 mL, with a range of 0.5‐9.0 mL. Reported adverse effects included three cases of prolonged pain, but no dysesthesias were reported during the follow‐up period (>40 days). Conclusions Phenol neurolysis with ultrasound and EStim guidance was successfully and safely used to manage focal spasticity in the distal upper extremity. Level of Evidence III.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity

Karri

Zhang

2019

PM&R

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“…Chemoneurolysis via localized injections can help provide focal spasticity relief (1,3,6). In addition, the use of single-event multi-level chemoneurolysis helps treat several areas of muscle spasticity, each with varying severities (7). Medications used in chemo neurolysis procedures include botulinum neurotoxin (BoNT), phenol, and alcohol neurolysis (3)(4)(5)(6)(7).…”

mentioning

confidence: 99%

“…In addition, the use of single-event multi-level chemoneurolysis helps treat several areas of muscle spasticity, each with varying severities (7). Medications used in chemo neurolysis procedures include botulinum neurotoxin (BoNT), phenol, and alcohol neurolysis (3)(4)(5)(6)(7). Compared with phenol and the understudied alcohol neurolysis, BoNT usage in treating spasticity is documented extensively in the literature with regards to pharmacodynamics, adverse effects and clinical benefits (7)(8)(9).…”

mentioning

confidence: 99%

“…Medications used in chemo neurolysis procedures include botulinum neurotoxin (BoNT), phenol, and alcohol neurolysis (3)(4)(5)(6)(7). Compared with phenol and the understudied alcohol neurolysis, BoNT usage in treating spasticity is documented extensively in the literature with regards to pharmacodynamics, adverse effects and clinical benefits (7)(8)(9). However, the response to chemodenervation with BoNT often requires 3-5 days to generate modalities, nerves targeted, dosages used, reported subjective benefit, and adverse effects were included.…”

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confidence: 99%

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Practice patterns for spasticity management with phenol neurolysis

Karri¹,

Mas²,

Francisco³

et al. 2017

J Rehabil Med

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Phenol neurolysis is currently used to reduce spasticity for various functional goals, including preventing contractures and improving gait. Depending on the pattern of spasticity displayed, numerous peripheral nerves in the upper and lower extremities can be targeted for treatment with phenol neurolysis. Further research into its role in spasticity management, including studies exploring its cost-effectiveness and pharmacological and side-effects compared with other treatment options are needed.

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Safety and effectiveness of ethanol neurolysis with and without onabotulinumtoxinA in children with cerebral palsy

Shoval

Jessica

Reddy

et al. 2023

PM&R

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BackgroundOnabotulinumtoxinA is commonly used to relieve spasticity in children with neurologic disorders. Ethanol neurolysis may be used to target more muscles but is less well studied, especially in pediatrics.ObjectiveTo determine the safety and effectiveness of ethanol neurolysis with onabotulinumtoxinA injections compared to only onabotulinumtoxinA injections for the treatment of spasticity in children with cerebral palsy.DesignProspective cohort study including patients with cerebral palsy receiving onabotulinumtoxinA and/or ethanol neurolysis from June 2020 to June 2021.SettingOutpatient physiatry clinic.PatientsA total of 167 children with cerebral palsy not undergoing other treatments during injection period.InterventionsInjection with either onabotulinumtoxinA only (112 children) or a combination of ethanol and onabotulinumtoxinA injections (55 children) using both ultrasound guidance and electrical stimulation.Main outcome measuresA post‐procedure evaluation at 2 weeks after injection documented any adverse effects experienced by the child and perceived magnitude of improvement using an ordinal scale from 1 to 5. Multiple linear regression was used to identify and control for covariates including Gross Motor Function Classification System, gender, age, weight, ethnicity, race, and dosage.ResultsOnly weight was identified as a confounding factor. When controlled for weight, combined onabotulinumtoxinA and ethanol injections had a greater magnitude of improvement (3.78/5) compared with onabotulinumtoxinA injections alone (3.44/5), a difference of 0.34 points on the rating scale (95% confidence interval: 0.01–0.69; p = .045). However, the difference was not clinically significant. One patient in the onabotulinumtoxinA‐only group and two patients in the combined onabotulinumtoxinA and ethanol group reported mild, self‐limiting adverse effects.ConclusionEthanol neurolysis under ultrasound and electrical stimulation guidance may be a safe and effective treatment for children with cerebral palsy that allows more spastic muscles to be treated than onabotulinumtoxinA alone.

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A Retrospective Review of Unintended Effects After Single‐Event Multi‐Level Chemoneurolysis With Botulinum Toxin‐A and Phenol in Children With Cerebral Palsy

Cited by 19 publications

References 25 publications

Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity

Phenol Neurolysis for Management of Focal Spasticity in the Distal Upper Extremity

Practice patterns for spasticity management with phenol neurolysis

Safety and effectiveness of ethanol neurolysis with and without onabotulinumtoxinA in children with cerebral palsy

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