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

Abstract

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.