Comparison of Efficacy of Botulinum Toxin A and Intramuscular Ethyl Alcohol Injection on Gastrocnemius Muscle Spasticity and Functional Outcomes in Cerebral Palsy Patients - Double Blinded Randomized Clinical Study

STUDY DESIGN: Double, blinded randomised clinical study OBJECTIVE: Most children affected with spastic diplegic cerebral palsy have motor disorder, spastics being the foremost common. Spastic CP is difficult to treat further more to rehabilitate. Among the varied modalities of treatment for spastic CP, ethyl alcohol and botulinum A has been gaining popularity because of their localised result, negligible general side effect, easy application and improved practical outcome of patient. Various studies are done over years on the advantages and practical outcome on use of ethyl alcohol and botulinum A in treating spasticity in CP patients, however there's lack of studies on the practical outcome on use of these agents. MATERIAL AND METHOD: From 2016 to 2018, a total of seventeen sample legs were recruited with predominantly gastrocnemius spasticity in spastic CP patients and randomly divided into 2 groups of ethyl alcohol and botulinum A injectionsusing computer generated random block organization. Group 1 was injected 50 % ethyl alcohol and group 2 got botulinum A - 4units/kg of bodyweight followed by five days of Above Knee cast in maximum dorsiflexion followed by physiotherapy and AFO splint. Pre and post intervention muscle spasticity and power, GMFM rating and active and passive Ankle Range of motion were recorded and follow up at 6 months. Statistical analysis was done by paired t test and continual multivariate analysis test (ANOVA). RESULT: There was no significant difference of improvement in spasticity among the each ethyl alcohol and botulinum toxin A group (37.5% vs 33.33% of patients) and significant improvement of gastrocnemius power in 75% of patients vs 11.11% of patients in ethyl alcohol group. There was no significant difference of improvement of GMFM score 8.25±7.58 in botulinum toxin A group vs 7.85±4.63 in ethyl alcohol group (p=0.916). There was no significant difference of improvement of total passive Ankle ROM 13.75±11.5 in botulinum toxin