Botulinum Toxin and Phenol (Injected Spasticity Medications)

At Gillette Children’s Specialty Healthcare, we offer comprehensive evaluations, treatments and services for children, teens and adults who have muscle spasticity. Gillette offers all available treatment options—including botulinum toxin and phenol injections—to manage spasticity associated with cerebral palsy or other complex conditions.

Why Choose Gillette?

  • Gillette is one of the world’s top cerebral palsy treatment centers, offering access to experts in muscle spasticity and related treatments.
  • We are nationally and internationally recognized in pediatric orthopedics and are regional leaders in neurosurgery and neurology.
  • We offer interdisciplinary spasticity evaluations for children, teens and adults.
  • We tailor spasticity management to the needs and goals of patients and families.
  • Our team approach to spasticity evaluations and subsequent treatments has resulted in superb measurable outcomes.


Botulinum toxin A is a protein injected directly into muscles as a medicine. It’s used to treat muscle spasticity—overly tight muscles caused by disrupted communication among the brain, spinal cord and peripheral nerves. Botulinum toxin blocks messages sent from nerves to the muscle that tell the muscle to contract. Spasticity is reduced when these messages are blocked, increasing comfort and improving function. Phenol is a chemical injection that works similarly to botulinum toxin.

Botulinum Toxin and Phenol Injection Candidates

Children who are too young for surgery or who only have spasticity in one or two muscles often benefit the most from injected medications. Botulinum toxin or phenol might not eliminate the need for surgery or for generalized treatments of spasticity. The medications, however, can allow families to delay a surgical procedure until a child is older.

Injected medications often help children, teens and adults whose spasticity is associated with the following conditions. This type of treatment might not be suitable for some patients—especially patients who have severe, widespread muscle spasticity and patients who have permanent muscle contractures that have become rigid.

Cerebral Palsy

When people who have cerebral palsy receive injected medications, their braces might fit better and their movement abilities often improve. After the medication causes spastic muscles to relax, physical or occupational therapists might work with patients to stretch the muscles, helping to limit contractures and bone deformities.

Therapists might also help patients practice functional movements. Some patients use casts for several weeks after an injection to give their relaxed spastic muscles a constant stretch. We might recommend orthoses to continue stretching the muscles.

Brain Injuries

Injected medications, combined with physical therapy, occupational therapy and casting, can sometimes limit muscle contractures that form after a brain injury. Medication might also help relax muscles and improve a person’s ability to walk, grasp things, extend the arms, or perform other functions.

Spinal Cord Injuries

When a person has a spinal cord injury, some messages between the brain and the spinal cord might not get through. Injected medications might make it easier for people who have spinal cord injuries to perform some movements. The medication might also help them feel more comfortable.

What to Expect

In some cases, patients receive a combination of both botulinum toxin and phenol injections. Botulinum toxin injections are often more effective in smaller muscles and phenol might be more effective in larger muscles.

Botulinum toxin typically takes effect in three to seven days and last for three to six months. We usually give the injections during a short clinic visit, when we inject botulinum toxin into several muscles. There are virtually no side effects from the medication itself, but patients might feel a sting or a pinch at the injection site. To make patients more comfortable during the botulinum toxin procedure, we might offer the following medications or services.

  • Topical creams or sprays that numb the skin at the injection site
  • Medicines to reduce anxiety
  • Child life specialists who provide distractions, diversions or relaxation techniques
  • Nitrous oxide as anesthesia

To inject phenol, we must sedate patients. During this procedure, we first locate the nerves to be blocked using stimulation (mild electrical impulses from a small battery-operated box). This enables specialists to place the phenol solution directly on the nerve. The process of finding the nerve might take 10 to 30 minutes. Phenol typically takes effect immediately and lasts four to 12 months. Possible side effects include temporary swelling, soreness or numbness at the injection site.

After botulinum toxin injections, patients usually return to their normal activities. In some cases, we ask that patients adjust their physical therapy program or wear a cast or splint to help stretch the joint or muscles. After phenol injections, we might recommend rest and gentle stretching for one to two weeks following the procedure.

Botulinum Toxin and Phenol Injection Outcomes

Results from botulinum toxin or phenol injections differ depending on a patient’s medical condition the severity of the muscle spasticity. Results often include:

  • Improved range of motion
  • Greater ease in stretching
  • Improved tolerance for wearing braces
  • Improved coordination
  • Specific gait (i.e., walking) changes

Over time, we can repeat the injections when the medication’s effects wear off. There are no long-term side effects or permanent results.

Our Botulinum Toxin and Phenol Injection Services

Effective treatment for spasticity requires a team approach. That’s why Gillette brings together experts in a variety of disciplines to develop custom treatment plans. Our goal is to achieve the best possible outcomes for our patients.

Spasticity treatments might also involve experts in the following Gillette specialties and services:

For more information about the comprehensive services we provide at Gillette, search Conditions and Care.

Why Gillette?

Because all children deserve a lifetime of amazing health care.

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