Botox reaction and Rhizotomy Advice

[Michele__0__0]

  My 3-yo with mild spastic diplegia just had her first Botox injections.  This was done under anesthesia (nitrous, sevo, formyl) and was EMG guided.  Her adductors and hamstrings, bilaterally were targeted.  30 minutes after the procedure we noted a hive-like rash (mild to moderate) on both of her legs.  30 minutes later we noted it on her right arm.  It resolved on its own within 2 hours post-procedure.  My questions are: Was this a typical Botox allergic reaction?  Could it have been the anesthesia?  Should we attempt Botox injections again?  Are there things we can do to R/O Botox vs anesthesia allergy?
  Also, we are considering relocating to either Boston or Seattle.  Are there good rhizotomy programs in either of those cities?  If so, at what institution(s)?
  Thank you for your help!
  Michelle

Dear Michelle:
In the setting that you describe, it is very difficult to discern whether
this was a reaction to Botox or one of the anesthetic agents. Despite this
I think that most clinicians would tell you that the likelihood that this is related to
Botox is slightly higher than the anesthesia effect.
I would discuss with your physician whether attempting Botox again is a good
idea.
Both Boston and Seattle have excellent places for evaluation and treatment of
spasticity and do have rhizotomy programs (University of Washington, and
Boston's Children's hospital).
I hope this helps!
Good Luck!