Article

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). DESIGN: Retrospective chart review. SETTING:
Pediatric rehabilitation outpatient clinic at an academic medical center.
PARTICIPANTS: The study included 98 children with CP who underwent SEMLC on at
least one occasion. INTERVENTIONS: SEMLC.
MAIN OUTCOME MEASURES:
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.
CI - Copyright (c) 2015 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS