Pediatric chemodenervation injections

What are pediatric chemodenervation injections?

Chemodenervation injections are a treatment designed to relieve spasticity. The care team uses a small needle to inject medication directly into your child’s muscle to improve that muscle’s function and range of motion. This treatment works best when we use it along with Pediatric physical therapy (PT) to help your child move and strengthen their muscles.

Each child responds a little differently to these injections, and they work better for some children than others. Your child’s care team works closely with your child to determine whether chemodenervation injections may be right for them.

What is spasticity?

Spasticity is a muscle control disorder that causes prolonged muscle contractions and extreme muscle tightness. The condition can interfere with your child’s ability to move and do daily activities, such as getting dressed or brushing their teeth.

Spasticity can occur with a variety of conditions, including:

• Cerebral palsy
• Traumatic brain injury
• Torticollis
• Genetic conditions, such as Down syndrome
• Transverse myelitis
• Spinal cord injury
• Stroke

What medications are used for pediatric chemodenervation injections?

The two main types of medications we use for chemodenervation injections are:

1. Botulinum toxin - This medication is commonly known as Botox^®, Xeomin^® or Dysport^®. Botulinum toxin helps block brain signals that tell a child’s muscles to contract. We use this treatment along with physical therapy to help lengthen a child’s muscles and improve overall function. We can also inject salivary glands with botulinum toxin to control excessive drooling, which is common in conditions like cerebral palsy.
2. Phenol - This medication creates a temporary nerve block that lasts a few months. We perform phenol injections in the operating room while your child is under anesthesia or as an outpatient treatment. The procedure takes only a few minutes, so if your child needs another procedure that requires anesthesia, we try to do both at the same time. We use phenol injections for children who have severe spasticity that is not responding well enough to botulinum toxin alone.

What are the benefits of pediatric chemodenervation injections?

Key benefits to chemodenervation injections include:

• Targeted, fast relief - Chemodenervation injections directly target specific muscles, providing faster relief than other treatments such as oral medication.
• Adjustable treatment - The effects of chemodenervation injections gradually wear off in about three to four months. We can repeat the injections about every four to five months, if needed, and adjust the dosage over time.
• Long-term treatment option - Your child can have several injections over the course of about a year, and most children can continue this treatment as long as needed.
• Delay or prevention of spasticity worsening - If left untreated, spasticity can cause increased pain, pressure sores and permanent limb contractures. These injections can help prevent these serious complications.
• Alternative to surgery - Chemodenervation injections can help delay or avoid the need for your child to have surgery to alleviate extreme muscle tension.
• Improved comfort and quality of life for your child - The main goal of treatment is to help your child move and function better so that they can become more active and independent.

What are the side effects of pediatric chemodenervation injections?

The side effects of chemodenervation injections vary based on the type your child gets.

Side effects of botulinum toxin injections

Most side effects of botulinum toxin injections go away within about two to three days after treatment. Side effects may include:

• Soreness and redness at injection site
• Low-grade fever
• General discomfort, pain or achiness

Side effects of phenol injections

The main side effect for phenol injections is discomfort at the injection site for one to two days. Because this treatment requires general anesthesia, children may experience side effects from general anesthesia such as nausea or disorientation when waking.

What are the risks of pediatric chemodenervation injections?

Chemodenervation injections are safe and effective, but they have possible risks, just like any treatment.

The risks are rare and temporary, and they may include:

• Possible spread to other areas - Sometimes, the treatment can affect nearby muscles that were not injected.
• Temporary problems with swallowing - This risk is mostly associated with injections in the neck.
• Nerve-related pain - In rare cases, nerve pain can last for two to three weeks.

Before we recommend chemodenervation injections, your child will undergo a thorough evaluation, which helps limit the likelihood of these risks. Should they arise, your child’s care team will work with you to navigate them.

What to expect with pediatric chemodenervation injections

First, our team performs a physical exam to confirm that your child needs injections and creates a treatment plan. Next, we will work to confirm coverage with your health insurance company. Then, we will schedule an injection session for your child. This whole visit will take an hour.

What to expect before pediatric chemodenervation injections

We rarely need to put your child under general anesthesia unless they are having phenol injections as well. That means your child can have the injections at an outpatient location and then go home soon after. In most cases, your child may eat, drink, and take any medications they need prior to the injections.

Sometimes, we will give your child an anti-anxiety medication before the injections to help them stay relaxed. If you child needs this medication, our nurses will help guide you on how to prepare your child for the appointment.

We reassess your child over the course of treatment to ensure that the injections are working and adjust them as needed. We also obtain consent from you and your child before we begin.

What to expect during pediatric chemodenervation injections

First, we apply a topical anesthetic to your child’s skin where we plan to insert the needle. Then, we insert the needle into the muscle. Whenever possible, we communicate with your child at every step of the process so there are no surprises.

Sometimes, we use electrical stimulation to help confirm the targeted area for treatment. For some children, this part of the procedure can be uncomfortable but not painful.

What to expect after pediatric chemodenervation injections

After the procedure, you can take your child home right away. If they had anesthesia, you’ll need to stay with them at the clinic until they fully awaken. Once you take your child home, you can give them ibuprofen or acetaminophen if they experience pain, soreness or aches.

What questions should I ask my provider about pediatric chemodenervation injections?

You may want to ask your child’s care team:

• How many chemodenervation injections have you performed?
• Are there other treatment options for my child?
• Will these medications have any potential interactions with my child’s other prescriptions?
• Can I be with my child during the procedure? If not, how soon will I be able to see my child afterward?