Botulinum toxin and short-term electrical stimulation in the treatment of equinus in cerebral palsy

Intramuscular botulinum toxin type A (BT-A) has been shown to reduce spasticity and to improve gait in children with cerebral palsy. To determine whether the efficacy of BT-A may be enhanced by electrical stimulation, as suggested in focal dystonia or in adult spastic patients, 12 children with dynamic foot equinus deformity were randomly assigned to two groups in a blinded, clinically controlled trial. Intramuscular BT-A into calf muscles was followed by adjuvant electrical stimulation in Group A (n = 6) but not in Group B (n = 6). Clinical assessment and instrumented gait analysis were performed before and 1, 3, and 6 months after treatment. The combined treatment of BT-A and electrical stimulation was not superior to BT-A alone. For all patients, improvement of the clinical and gait variables occurred at 1 and 3 months after BT-A injection.