title: Combining botulinum toxin and phenol to manage spasticity in children.
abstract: OBJECTIVE
  To describe the specific techniques and adverse reactions of using concurrent, multiple injections of both botulinum toxin and phenol to manage spasticity in children with cerebral palsy (CP) and other neurologic conditions.
  
  
  METHODS
  A retrospective case series.
  
  
  METHODS
  A tertiary care children's hospital.
  
  
  METHODS
  Consecutive patients (N=68) with spasticity related to CP or other neurologic conditions.
  
  
  METHODS
  Ninety injection sessions combining botulinum toxin and phenol to manage spasticity.
  
  
  METHODS
  Documentation of adverse reactions.
  
  
  RESULTS
  The mean phenol dosage was 9.5mL at a mean of 0.6mL/kg per injection dose. The mean botulinum toxin type A (Botox) dose injected was 193U (12U/kg), and the mean of botulinum toxin type B (Myobloc) dose injected was 7750U (530U/kg). The mean number of muscles injected was 14. Adverse reactions are described but were infrequent. Dysesthetic hand pain occurred in 2 patients. One patient developed a systemic reaction to Myobloc.
  
  
  CONCLUSIONS
  Using botulinum toxin and phenol injections allowed many muscles to be injected to manage spasticity in children with CP and other neurologic conditions. Using this combination allowed an increased number of injections at the maximal recommended dose.
authors.affiliation: Primary Children's Medical Center, 100 N. Medical Drive, Salt Lake City, UT 84112, USA. pcjgooch@ihc.com
authors.forename: Judith L
authors.initials: JL
authors.lastname: Gooch
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Patton
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002547:Cerebral Palsy / Q000188:drug therapy* / Q000534:rehabilitation; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D009128:Muscle Spasticity / Q000517:prevention & control; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D019800:Phenol / Q000008:administration & dosage*; D012189:Retrospective Studies
chemical_list: D009465:Neuromuscular Agents; D019800:Phenol; D019274:Botulinum Toxins, Type A