Early Use of Phenol Neurolysis Likely Reduces the Total Amount of Botulinum Toxin in Management of Post-Stroke Spasticity.

This is a retrospective chart review, so it cannot prove that phenol caused the reduction in BoNT dose; it only shows an association. The study did not use clinical scales like the Modified Ashworth Scale to measure spasticity directly, so it is unclear if the lower BoNT dose reflected better spasticity control or simply different treatment patterns. Side effects may have been underestimated because minor issues are often not documented in medical charts. The study population was limited to patients admitted to a single inpatient rehabilitation facility, which may not reflect broader practice. The decision to use phenol or BoNT was based on clinical judgment and consensus, not randomization, introducing potential selection bias. The study did not assess long-term motor recovery or functional outcomes, so it is unknown if the reduced BoNT dose affected the patient's overall rehabilitation progress.

One author (SL) is a consultant for SAOL Therapeutics for the research protocol development of a new phenol. The authors declare no other commercial or financial relationships.

Do not interpret the lower botulinum toxin dose in the Phenol-First group as proof that phenol is more effective at reducing spasticity. The study did not measure spasticity directly using clinical scales, so the lower dose could reflect different treatment targets or clinical judgment rather than superior efficacy.