Peer-reviewed article
Safety and effectiveness of ethanol neurolysis with and without onabotulinumtoxinA in children with cerebral palsy
Hannah Aura Shoval, Jessica C. Ace, Mayuri R. Reddy, Emily C. Grew, JenFu Cheng ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study compared two injection treatments for spasticity in children with cerebral palsy: onabotulinumtoxinA alone versus a combination of ethanol neurolysis and onabotulinumtoxinA. The combined treatment showed slightly greater improvement in symptom relief, but the difference was too small to matter clinically. Both treatments were safe, with only three children reporting mild, short-lived side effects.
Key points
- Combined ethanol and onabotulinumtoxinA injections showed a mean improvement score of 3.78/5 compared to 3.44/5 for onabotulinumtoxinA alone
- The statistical difference of 0.34 points on the 5-point scale was not clinically significant
- Only weight was identified as a confounding factor; other variables like age, gender, and cerebral palsy severity did not significantly affect outcomes
- Both treatments had excellent safety profiles with only 3 adverse events (1 in single-treatment group, 2 in combined group), all mild and self-limiting
- Combined treatment allows more spastic muscles to be treated than onabotulinumtoxinA alone
Limitations
This was a prospective cohort study without randomisation, so groups may have differed in unmeasured ways and causality cannot be firmly established. Outcome measurement relied on parent or caregiver perception of improvement rather than objective clinical measures.
Abstract
BACKGROUND: OnabotulinumtoxinA is commonly used to relieve spasticity in children with neurologic disorders. Ethanol neurolysis may be used to target more muscles but is less well studied, especially in pediatrics. OBJECTIVE: To determine the safety and effectiveness of ethanol neurolysis with onabotulinumtoxinA injections compared to only onabotulinumtoxinA injections for the treatment of spasticity in children with cerebral palsy. DESIGN: Prospective cohort study including patients with cerebral palsy receiving onabotulinumtoxinA and/or ethanol neurolysis from June 2020 to June 2021. SETTING: Outpatient physiatry clinic. PATIENTS: A total of 167 children with cerebral palsy not undergoing other treatments during injection period. INTERVENTIONS: Injection with either onabotulinumtoxinA only (112 children) or a combination of ethanol and onabotulinumtoxinA injections (55 children) using both ultrasound guidance and electrical stimulation. MAIN OUTCOME MEASURES: A post-procedure evaluation at 2 weeks after injection documented any adverse effects experienced by the child and perceived magnitude of improvement using an ordinal scale from 1 to 5. Multiple linear regression was used to identify and control for covariates including Gross Motor Function Classification System, gender, age, weight, ethnicity, race, and dosage. RESULTS: Only weight was identified as a confounding factor. When controlled for weight, combined onabotulinumtoxinA and ethanol injections had a greater magnitude of improvement (3.78/5) compared with onabotulinumtoxinA injections alone (3.44/5), a difference of 0.34 points on the rating scale (95% confidence interval: 0.01-0.69; p = .045). However, the difference was not clinically significant. One patient in the onabotulinumtoxinA-only group and two patients in the combined onabotulinumtoxinA and ethanol group reported mild, self-limiting adverse effects. CONCLUSION: Ethanol neurolysis under ultrasound and electrical stimulation guidance may be a safe and effective treatment for children with cerebral palsy that allows more spastic muscles to be treated than onabotulinumtoxinA alone.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Ethanol neurolysis combined with onabotulinumtoxinA injections, using ultrasound guidance and electrical stimulation, compared to onabotulinumtoxinA injections alone
- Population
- 167 children with cerebral palsy (112 in onabotulinumtoxinA-only group, 55 in combined group) not undergoing other treatments during the injection period
Key finding
Combined ethanol and onabotulinumtoxinA achieved mean improvement of 3.78/5 versus 3.44/5 for onabotulinumtoxinA alone (difference 0.34 points, 95% CI 0.01-0.69, p=0.045)