Safety profile of multilevel chemical denervation procedures using phenol or botulinum toxin or both in a pediatric...

To investigate the safety of single and repeated multilevel injections of botulinum toxin (BoNT) alone or a combination of phenol and BoNT performed under general anesthesia in children with chronic muscle spasticity.

Retrospective cohort study. Data from 336 children who received a total of 764 treatments were analyzed. Mean age was 7.4 yrs, and 90% had diagnoses of cerebral palsy.

The overall complication rate was 6.8%, similar to rates reported in comparable studies of BoNT alone and combined BoNT and phenol. Of the total number of injection sessions with complications, 1.2% were anesthesia related and 6.3% were injection related; none resulted in any deaths or long-term morbidity. Injection-related complications were most frequently local symptoms of short duration. These were comparable with those reported previously, except that in this series there was a rare occurrence of dysesthesias (0.4%) with phenol injections. Complications occurred more frequently in patients injected with a combination of phenol and BoNT vs. BoNT alone, but no single causal factor can be implicated. No increase in complications with repeat injections was observed, and there was no correlation of complication rates with dosage of either agent.

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