Phenol and Alcohol

Phenol and alcohol are injected with a fine needle directly onto nerves or into muscles to destroy them. Phenol and alcohol can effectively weaken a spastic muscle, thereby reducing spasticity and allowing improvements in range of motion. These agents are effective in treating spasticity that occurs in large, powerful muscle groups close to the trunk, such as those of the thigh. Alcohol or phenol may be used in combination with BTX, and all may be combined with other antispasticity treatments. The duration of effect is quite variable, from less than 1 month to more than 2 years.

The cost of either phenol or alcohol is much less than that of BTX. When cost is a major concern, phenol or alcohol may be used to treat muscles in which BTX could also be effective. Unlike BTX, phenol and alcohol do not provoke a reaction by the immune system. Because the amount and frequency of the dose is not limited by this issue, larger muscles may be treated more effectively.

There are several significant disadvantages to the use of phenol and alcohol. Phenol and alcohol may produce more troublesome initial side effects than BTX, such as burning and odd sensations called dysesthesias. Damage to nearby sensory nerves may cause temporary or permanent pain, which may require medication to control. Surgery may be required to expose the target nerve. The mechanism of action for both agents is to destroy tissue, and muscle near the injection site is usually damaged along with the target nerves. Exposure to phenol, though not alcohol, theoretically increases the risk of developing leukemia, although no studies have shown an increased incidence of leukemia as a result of spasticity treatment.

	Surgical Treatments