Aim: The aim of this paper was to compare between the various effects of botulinum toxin type A (BT-A) when it is injected at gastrocnemius or adductors or at both sites in ambulant spastic hemiplegic cerebral palsy (CP) children.
Methods: Sixty ambulant CP children with spastic hemiplegia were chosen. They were divided into 4 equal homogenous groups. Study groups (A, B, and C) received 3 successive injections of BT-A at 3 to 4 months interval. The injection sites were as follows: gastrocnemius for group A; adductors for group B; gastrocnemius and adductors for group C. Group D received no injections and was considered as a control group. Muscle tone and gait evaluation were conducted for every child in the BT-A groups at his entry and 6 months after the last injection dose. Also, the same evaluation protocol was conducted for every child in the control group at his entry and after 6 month's period.
Results: When BT-A groups were compared to the control group, results showed significant improvement in muscle tone following injection in all BT-A groups. A statistically significant increase of the unaffected step length and decrease of step width and foot angle was noted in gastrocnemius group (P=0.04, P=0.003, P=0.002) respectively, as well as in gastrocnemius/adductors group (P=0.006, P=0.002, P=0.003), respectively. However, the cadence and speed of walking showed significant increase in the gastrocnemius/adductors group; only P=0.03, P=0.004 respectively. Comparing between BT-A groups, there was significant improvement in all parameters between adductors and gastrocnemius/adductors groups in favor of the last group. Moreover, there was significant improvement in muscle tone (P=0, cadence P=0.04), and speed of walking P=0.01 between gastrocnemius and gastrocnemius/adductors groups in favor of the last group; however, there was no significant difference between these 2 groups in respect to the step width P=0.96 and the foot angle P=0.92.
Conclusions: Our findings indicate that, in spastic hemiplegic CP, botulinum toxin has a better effect on tone reduction and improvement of gait parameters when it is given at the gastrocnemius and adductors muscles collectively.