Safety Profile of Multilevel Chemical Denervation Procedures Using Phenol or Botulinum Toxin or Both in a Pediatric Population

Abstract

Although these procedures are not without adverse effects, this series suggests that the potential benefits outweigh the risks.

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

“…The overall incidence of UEs in this study was higher (21%) than in previous studies with the same combinedagent treatment (about 7%) [15,16]. However, the findings may not be comparable because of a difference in the data retrieval criteria.…”

“…Soreness at injection sites could be from a mechanical effect of the needle [22], in addition to stinging pain from phenol because of its nature as an astringent. Kolaski et al [16] reported similar resultsdthat is, tenderness, bruising, and swelling occurred more frequently in sites injected with phenol compared with BTX-A. Adhesive bandages were applied over the phenol injection sites as landmarks so the caregivers could apply ice compression to decrease the pain.…”

“…However, the findings may not be comparable because of a difference in the data retrieval criteria. The present study reported all of the UEs noted in follow-up medical records, whereas Kolaski et al [16] recorded injectionrelated symptoms only if the symptoms were noted to persist more than 3 days. Gooch and Patton [15] did not count difficulty walking for several days after the injections as UEs, whereas the weakness that resulted in difficulty walking was the most common UE in the present study.…”

“…Despite the theoretical advantages of combined-agent treatment, the evidence of the safety profile and clinical outcome is very limited and contradictory. Whereas Gooch and Patton [15] reported infrequent complications of combined treatment with a rate similar to those reported in previous studies using either BTX or phenol alone, Kolaski et al [16] reported that combined-agent procedures had more UEs than the injections with BTX alone, but no single causal factor was found.…”

Increasing physical function through physiatric intervention for children with paediatric neurotransmitter disorders

“…Uptake of the toxin into the nerve terminal over the next several days results in a pre-synaptic blockade at the neuromuscular junction, resulting in decrease in tone (Koman 2000). The effects of phenol and botulinum toxin are temporary, and although the injections are technically easy, the drugs are potentially fatal and must be administered by a physician well trained in the indications and proper dosing techniques for the drug (Kolaski et al 2008;Koman et al 2003).…”