COMPARISON OF EFFICACY OF BOTULINUM INJECTION WITH SURGICAL RELEASE IN CEREBRAL PALSY CHILDREN WITH FOOT EQUINUS

Abstract

Objective: To compare the efficacy of surgical release and Botulinum Toxin injections for treating foot equinus in Cerebral Palsy (CP) patients. Methodology: This Quasi-experimental study was conducted in the Orthopedic Department, Khyber Teaching Hospital (KTH) Peshawar-Pakistan. The study enrolled 60 patients from 1st March 2018 to 1st June 2019 via non-probability consecutive sampling. All diagnosed cases of CP with equinus foot of either gender and age between 4-18 years with no previous surgery or botulinum injections and no joint deformity were included; while all patients with myasthenia gravis, neuromuscular junction disease, use of aminoglycoside, and those with dis-continued physiotherapy were excluded. The patients were distributed into two equal groups, group A (botulinum group) and group B (surgery group). The outcome of the interventions in each group was measured based on improvement in Gross Motor Function Measure-66 (GMFM-66). Data was analysed using SPSS v.21.0, descriptive and analytical analysis was conducted where needed. Results: The mean age of patients was 11.47±4.01 years with male to female ratio of 1.22:1. The right and left foot distribution among the patients was 31 (52%) and 29 (48%) respectively. Botulinum type A (BTX-A) injection resulted in improvement of GMFM-66 score in 27 (90%) patients in group A while the surgical release was effective in 20 (66.7%) patients in group B in terms of improvement in GMFM-66 score. Conclusion: The study concluded that Botulinum Toxin has much better effectiveness as compared to surgical release in treatment of foot equinus among CP patients.