{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T15:51:58Z","timestamp":1747151518864,"version":"3.40.5"},"reference-count":21,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,5,28]],"date-time":"2023-05-28T00:00:00Z","timestamp":1685232000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective cohort study including patients with cerebral palsy receiving onabotulinumtoxinA and\/or ethanol neurolysis from June 2020 to June 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Outpatient physiatry clinic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>A total of 167 children with cerebral palsy not undergoing other treatments during injection period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Injection with either onabotulinumtoxinA only (112 children) or a combination of ethanol and onabotulinumtoxinA injections (55 children) using both ultrasound guidance and electrical stimulation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>A post\u2010procedure evaluation at 2\u2009weeks 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u20130.69; <jats:italic>p<\/jats:italic>\u2009=\u2009.045). However, the difference was not clinically significant. One patient in the onabotulinumtoxinA\u2010only group and two patients in the combined onabotulinumtoxinA and ethanol group reported mild, self\u2010limiting adverse effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pmrj.12973","type":"journal-article","created":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T08:40:26Z","timestamp":1679906426000},"page":"1419-1424","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Safety and effectiveness of ethanol neurolysis with and without <scp>onabotulinumtoxinA<\/scp> in children with cerebral palsy"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6130-015X","authenticated-orcid":false,"given":"Hannah A.","family":"Shoval","sequence":"first","affiliation":[{"name":"Department of Pediatric Physiatry Atlantic Health System  Morristown New Jersey USA"},{"name":"Department of Physical Medicine &amp; Rehabilitation Rutgers New Jersey Medical School  Newark New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica C.","family":"Ace","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine &amp; Rehabilitation JFK\u2010Johnson Rehabilitation Institute  Edison New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mayuri R.","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine &amp; Rehabilitation Rutgers New Jersey Medical School  Newark New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7094-1234","authenticated-orcid":false,"given":"Emily C.","family":"Grew","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine &amp; Rehabilitation Rutgers New Jersey Medical School  Newark New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JenFu","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine &amp; Rehabilitation Rutgers New Jersey Medical School  Newark New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,5,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2003.09.032"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0883073803018001S0701"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022\u2010510X(66)90027\u2010X"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469\u20108749.1980.tb04354.x"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2015.05.020"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.3233\/NRE\u20102012\u201000806"},{"issue":"1","key":"e_1_2_7_8_1","first-page":"5","article-title":"Comparison of phenol and alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle for treatment of spastic foot after stroke: a randomized controlled pilot study","volume":"46","author":"Kocabas H","year":"2010","journal-title":"Eur J Phys Rehabil Med"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2009.08.001"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.phm.0000118038.02326.ca"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.4103\/1658\u2010354X.101223"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/eujp.2001.0269"},{"issue":"1","key":"e_1_2_7_13_1","first-page":"20","article-title":"Treatment of spasticity in cerebral palsy by means of phenol nerve block of peripheral nerves","volume":"16","author":"Helweg\u2010Larsen J","year":"1969","journal-title":"Dan Med Bull"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/02699050010009775"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1053\/apmr.2000.9395"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.4103\/JMU.JMU_110_20"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.23736\/S1973\u20109087.18.05295\u20104"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.3233\/PRM\u2010180552"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0003\u20109993(99)90021\u20107"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.RVW.19.00119"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1191\/0269215502cr508oa"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/PHM.0b013e31817c115b"}],"container-title":["PM&amp;R"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmrj.12973","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T19:04:10Z","timestamp":1700679850000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pmrj.12973"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,28]]},"references-count":21,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1002\/pmrj.12973"],"URL":"https:\/\/doi.org\/10.1002\/pmrj.12973","archive":["Portico"],"relation":{},"ISSN":["1934-1482","1934-1563"],"issn-type":[{"type":"print","value":"1934-1482"},{"type":"electronic","value":"1934-1563"}],"subject":[],"published":{"date-parts":[[2023,5,28]]},"assertion":[{"value":"2022-08-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-03-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-28","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}