title: A Retrospective Review of Unintended Effects After Single-Event Multi-Level Chemoneurolysis With Botulinum Toxin-A and Phenol in Children With Cerebral Palsy.
abstract: BACKGROUND
  Single-event multi-level chemoneurolysis (SEMLC) is a single-session procedure that treats various limbs of patients with spasticity at multiple levels with chemoneurolytic agents. Phenol is used in combination with botulinum toxin A (BTX-A) to enable spastic muscles to be treated without overdosing with BTX-A.
  
  
  OBJECTIVE
  To review unintended effects (UEs) of SEMLC for children with spastic cerebral palsy (CP).
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Pediatric rehabilitation outpatient clinic at an academic medical center.
  
  
  METHODS
  The study included 98 children with CP who underwent SEMLC on at least one occasion.
  
  
  METHODS
  SEMLC.
  
  
  METHODS
  UEs, the goal achievement for each SEMLC session, and the Gross Motor Function Classification System (GMFCS-ER).
  
  
  RESULTS
  A total of 98 subjects and 146 SEMLC procedures were reviewed. Patients had a mean age of 7.56 years (standard deviation, 4.28); 57% were male; and 14 had hemiplegia, 22 had diplegia, 8 had triplegia, and 54 had quadriplegia. Most SEMLCs (72%) were performed with a combination of BTX-A and 5% phenol in a session. UEs were reported for 31/146 (21%) of SEMLC sessions, with 16 of 31 UEs being temporary weakness. The overall incidence of UEs of the group that received combined agent treatment was not different from the group that received BTX-A only (P = .267). Transient pain occurred in 7 of 105 patients who were treated with the combined agents BTX-A and phenol. Dysesthesia did not develop in any of the patients. The type of CP, GMFCS level, number of muscles injected, and doses of medications were not correlated with the incidence of UEs.
  
  
  CONCLUSIONS
  SEMLC using combined BTX-A and phenol is a safe procedure for children with spastic CP. It could be a treatment option for patients with diffuse spasticity, because combining agents allowed more muscles to be treated without enduring or serious UEs. Patient and family education is essential to prepare them for the occurrence of common UEs, such as temporary weakness and pain.
authors.affiliation: Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, 180 Fort Washington Ave, Suite 199, New York, NY 10032; Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Teerada
authors.initials: T
authors.lastname: Ploypetch
authors.affiliation: Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, 180 Fort Washington Ave, Suite 199, New York, NY 10032; Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jeong-Yi
authors.initials: JY
authors.lastname: Kwon
authors.affiliation: Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, 180 Fort Washington Ave, Suite 199, New York, NY 10032; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Hilary F
authors.initials: HF
authors.lastname: Armstrong
authors.affiliation: Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, 180 Fort Washington Ave, Suite 199, New York, NY 10032.
authors.forename: Heakyung
authors.initials: H
authors.lastname: Kim
mesh_terms: D019274:Botulinum Toxins, Type A; D002547:Cerebral Palsy / Q000150:complications / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000209:etiology / Q000628:therapy; D009407:Nerve Block / Q000009:adverse effects*; D009465:Neuromuscular Agents; D019800:Phenol; D012189:Retrospective Studies; D012597:Sclerosing Solutions
chemical_list: D009465:Neuromuscular Agents; D012597:Sclerosing Solutions; D019800:Phenol; D019274:Botulinum Toxins, Type A