1887
  1. Home
  2. A-Z Publications
  3. Journal of Emergency Medicine, Trauma and Acute Care
  4. Volume 2023, Issue 1
  5. Article
Volume 2023, Issue 1
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Phenol and botulinum toxin type A (BTX-A) injections are two options for treating spasticity with the ability to select a specific spastic muscle and determine the dosage based on spasticity degree. This study intends to compare the efficacy of BTX-A vs. phenol blockade in treating lower limb spasticity and to evaluate the performance improvement in gross motor functional outcomes among adult patients with upper motor neuron (UMN) lesions.

This randomized, double-blind clinical trial of 28 spastic lower limb adult patients with UMN was diagnosed between March 1, 2017, to April 30, 2019. Patients were randomized in a 1:1 ratio to a “BTX-A injections” or a “Phenol injections” group. The outcomes were measured through assessment spasticity by the Modified Ashworth Scale (MAS), active range of motion (AROM) of lower limb joint by a goniometer, Verbal Rating Scale (VRS), Visual Analog Scale (VAS), and Penn Spasm Frequency Scale (PSFS) as a baseline and post-injection follow-up at 24 hours, 3 weeks, and 3 months.

All 28 randomized patients were analyzed. No significant difference between the two study arms, neither in demographic characteristics nor in MAS, AROM, VRS, VAS, and PSFS parameters prior to the procedures. AROM showed a significant decrease from baseline throughout the study in the phenol group. While in the BTX-A group, they improved significantly at 3 weeks; no more improvement was observed at 3 months, and the differences were statistically significant ( < 0.05). The reduction in MAS, VRS, VAS, and PSFS was statistically significant in each group at 24 hours, 3 weeks, and 3 months after the injection ( < 0.05). However, the differences were not significant between the phenol and BTX-A groups ( > 0.05), except for PSFS at the 3 months of follow-up in the Phenol group ( = 0.01). The need for re-injection at 6 months and 9 months was that 5 patients vs. 0 patients ( = 0.01) and 8 patients vs. 3 patients ( = 0.04) in the BTX-A and phenol groups, respectively, were statistically significant.

Phenol injection showed superior treatment effects in AROM, decreased spasm degree based on PSFS at 3 months, and less-frequent re-injection rate compared to BTX-A injections in adult patients with UMN lesions. However, both phenol and BTX-A injections effectively reduce spasticity without significant differences in efficacy and adverse effects. Future studies must be conducted with a longer duration of follow-up, and larger sample sizes better to compare both drugs’ effectiveness and side effects.

The study protocol was registered as a clinical trial under registration IRCT20170826035914N2 at the Iranian Registry of Clinical Trials (http://www.irct.ir).

© 2022 Farpour, Parvar, Ahmed, Hajihosseini, Ghamari, Badheeb, Nikbakht, licensee HBKU Press.
Loading

Article metrics loading...

/content/journals/10.5339/jemtac.2023.4
2023-01-19
2025-01-23
Loading full text...

Full text loading...

/deliver/fulltext/jemtac/2023/1/jemtac.2023.4.html?itemId=/content/journals/10.5339/jemtac.2023.4&mimeType=html&fmt=ahah

References

  1. Li S. Spasticity, motor recovery, and neural plasticity after stroke. Front Neurol. 2017; 8::120.
     [Google Scholar]
  2. Patejdl R, Zettl UK. Spasticity in multiple sclerosis: Contribution of inflammation, autoimmune mediated neuronal damage and therapeutic interventions. Autoimmun Rev. 2017; 16::925–36.
     [Google Scholar]
  3. Garland DE, Lucie RS, Waters RL. Current uses of open phenol nerve block for adult acquired spasticity. Clin Orthop Relat Res. 1982:217–22.
     [Google Scholar]
  4. Gonnade N, Lokhande V, Ajij M, Gaur A, Shukla K. Phenol versus botulinum toxin A injection in ambulatory cerebral palsy spastic diplegia: A comparative study. J Pediatr Neurosci. 2017; 12::338–43.
     [Google Scholar]
  5. Schasfoort F, Pangalila R, Sneekes EM, Catsman C, Becher J, Horemans H, et al. Intramuscular botulinum toxin prior to comprehensive rehabilitation has no added value for improving motor impairments, gait kinematics and goal attainment in walking children with spastic cerebral palsy. J Rehabil Med. 2018; 50::732–42.
     [Google Scholar]
  6. Manca M, Merlo A, Ferraresi G, Cavazza S, Marchi P. Botulinum toxin type A versus phenol. A clinical and neurophysiological study in the treatment of ankle clonus. Eur J Phys Rehabil Med. 2010; 46::11–8.
     [Google Scholar]
  7. Simpson DM, Gracies JM, Yablon SA, Barbano R, Brashear A. Botulinum neurotoxin versus tizanidine in upper limb spasticity: a placebo-controlled study. J Neurol Neurosurg Psychiatry. 2009; 80::380–5.
     [Google Scholar]
  8. Hu GC, Chuang YC, Liu JP, Chien KL, Chen YM, Chen YF. Botulinum toxin (Dysport) treatment of the spastic gastrocnemius muscle in children with cerebral palsy: a randomized trial comparing two injection volumes. Clin Rehabil. 2009; 23::64–71.
     [Google Scholar]
  9. Kirazli Y, On AY, Kismali B, Aksit R. Comparison of phenol block and botulinus toxin type A in the treatment of spastic foot after stroke: a randomized, double-blind trial. Am J Phys Med Rehabil. 1998; 77::510–5.
     [Google Scholar]
  10. Bang MS, Chung SG, Kim SB, Kim SJ. Change of dynamic gastrocnemius and soleus muscle length after block of spastic calf muscle in cerebral palsy. Am J Phys Med Rehabil. 2002; 81::760–4.
     [Google Scholar]
  11. Carpenter EB, Seitz DG. Intramuscular alcohol as an aid in management of spastic cerebral palsy. Dev Med Child Neurol. 1980; 22::497–501.
     [Google Scholar]
  12. Mills PB, Holtz KA, Szefer E, Noonan VK, Kwon BK. Early predictors of developing problematic spasticity following traumatic spinal cord injury: A prospective cohort study. J Spinal Cord Med. 2020; 43::315–30.
     [Google Scholar]
  13. Li S, Francisco GE. The use of botulinum toxin for treatment of spasticity. Handb Exp Pharmacol. 2021; 263::127–46.
     [Google Scholar]
  14. Biering-Soerensen B, Stevenson V, Bensmail D, Grabljevec K, Moreno MM, Pucks-Faes E, et al. European expert consensus on improving patient selection for the management of disabling spasticity with intrathecal baclofen and/or botulinum toxin type A. J Rehabil Med. 2022; 54::jrm00241.
     [Google Scholar]
  15. Karri J, Zhang B, Li S. Phenol neurolysis for management of focal spasticity in the distal upper extremity. PM R. 2020; 12::246–50.
     [Google Scholar]
  16. Gormley ME, Jr. Treatment of neuromuscular and musculoskeletal problems in cerebral palsy. Pediatr Rehabil. 2001; 4::5–16.
     [Google Scholar]
  17. Smyth MD, Peacock WJ. The surgical treatment of spasticity. Muscle Nerve. 2000; 23::153–63.
     [Google Scholar]
  18. D’Souza RS, Warner NS. Phenol nerve block. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.
     [Google Scholar]
  19. Karri J, Mas MF, Francisco GE, Li S. Practice patterns for spasticity management with phenol neurolysis. J Rehabil Med. 2017; 49::482–8.
     [Google Scholar]
  20. Li S, Woo J, Mas MF. Early use of phenol neurolysis likely reduces the total amount of botulinum toxin in management of post-stroke spasticity. Front Rehabilit Sci. 2021; 2::729198.
     [Google Scholar]
  21. Kaishou X, Tiebin Y, Jianning M. A randomized controlled trial to compare two botulinum toxin injection techniques on the functional improvement of the leg of children with cerebral palsy. Clin Rehabil. 2009; 23::800–11.
     [Google Scholar]
  22. Blumetti FC, Belloti JC, Tamaoki MJ, Pinto JA. Botulinum toxin type A in the treatment of lower limb spasticity in children with cerebral palsy. Cochrane Database Syst Rev. 2019; 10::Cd001408.
     [Google Scholar]
  23. McGuire JR. Effective use of chemodenervation and chemical neurolysis in the management of poststroke spasticity. Top Stroke Rehabil. 2001; 8::47–55.
     [Google Scholar]
  24. Lui J, Sarai M, Mills PB. Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review. Spinal Cord. 2015; 53::252–64.
     [Google Scholar]
  25. Dy R, Roge D. Medical updates in management of hypertonia. Phys Med Rehabil Clin N Am. 2020; 31::57–68.
     [Google Scholar]
  26. Marciniak C, McAllister P, Walker H, Brashear A, Edgley S, Deltombe T, et al. Efficacy and safety of AbobotulinumtoxinA (Dysport) for the treatment of hemiparesis in adults with upper limb spasticity previously treated with botulinum toxin: Subanalysis from a phase 3 randomized controlled trial. PM R. 2017; 9::1181–90.
     [Google Scholar]
  27. Halpern D, Meelhuysen FE. Duration of relaxation after intramuscular neurolysis with phenol. JAMA. 1967; 200::1152–4.
     [Google Scholar]
  28. Shackley P, Shaw L, Price C, van Wijck F, Barnes M, Graham L, et al. Cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A: results from the botulinum toxin for the upper limb after stroke (BoTULS) trial. Toxins (Basel). 2012; 4::1415–26.
     [Google Scholar]
  29. Ro T, Ota T, Saito T, Oikawa O. Spasticity and range of motion over time in stroke patients who received multiple-dose botulinum toxin therapy. J Stroke Cerebrovasc Dis. 2020; 29::104481.
     [Google Scholar]
/content/journals/10.5339/jemtac.2023.4
Loading
Phenol vs. botulinum toxin A injection for managing lower limb spasticity in adult patients with upper motor lesions: A randomized clinical trial
Journal of Emergency Medicine, Trauma and Acute Care 2023, 4 (2023); https://doi.org/10.5339/jemtac.2023.4
/content/journals/10.5339/jemtac.2023.4
/content/journals/10.5339/jemtac.2023.4
Loading

Data & Media loading...

Keyword(s): botulinum toxin type A, clinical trial, lower limb, phenol and spasticity

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error