Xavier Vidal, Joan Martí-Fàbregas, Olga Canet, Marta Roqué, Antoni Morral, Miriam Tur, Christoph Schmitz, Mercè Sitjà-Rabert
Blanquerna School of Health Science, Ramon Llull University, Barcelona, Spain.
DOI: 10.2340/16501977-2703

Objectives: To investigate whether botulinum toxin type A (BTX-A) injection is more effective than radial extracorporeal shock wave therapy in reducing plantar flexor muscle spasticity in subjects with cerebral palsy.
Methods: A total of 68 subjects with cerebral palsy were randomly allocated to BTX-A injection (Group 1) or radial extracorporeal shock wave therapy (Group 2) (first experiment; E1). Outcome was evaluated using the Tardieu V1 and V3 stretches, at 3 weeks, 2 months (M2) and M3 after baseline. At M6 subjects in Group 1 received radial extracorporeal shock wave therapy and subjects in Group 2 received BTX-A injection (second experiment; E2); outcome was evaluated as in E1. Treatment success was defined as improvement in foot dorsiflexion ≥10° when performing the V3 stretch at M2 in both experiments.
Results: In both experiments mean V1 and V3 significantly improved over time. In E1 both treatments resulted in similar treatment success. In E2 fewer subjects treated with BTX-A injection reached the criteria of treatment success than did subjects treated with radial extracorporeal shock wave therapy, which was due to a carry-over effect from E1. No significant complications were observed.
Conclusion: BTX-A injection is not superior to radial extracorporeal shock wave therapy in the treatment of plantar flexor muscle spasticity in subjects with cerebral palsy.

Cerebral palsy is caused by a non-progressive disorder of the immature brain. In most subjects with cerebral palsy spasticity is the main motor disorder. Spasticity of the muscles that pull the foot upward is a particular problem in cerebral palsy, because it can result in disturbances in balance and walking. Botulinum toxin type A (BTX-A) injection is a widely used and effective treatment for spasticity. However, BTX-A is expensive and not available in many countries, and BTX-A injection is an invasive procedure that may cause pain. This study found that BTX-A injection is not superior to non-invasive radial extracorporeal shock wave therapy in managing spasticity of the muscles that pull the foot upward (both treatment modalities were combined with regular conservative therapy consisting of passive mobilization, balance work and coordination). How-ever, radial extracorporeal shock wave therapy is much cheaper and much less painful than BTX-A injection.