Comparison of phenol block and botulinus toxin type A in the treatment of spastic foot after stroke - A randomized, double-blind trial

Locally acting treatments for spasticity such as nerve and motor point bloc ks have the advantage of reducing harmful spasticity in one area, while pre serving useful spasticity in another area. This randomized, double-blind st udy is the first trial that was designed to find out whether botulinus toxi n Type A and phenol relieves the signs and symptoms of ankle plantar flexor and foot invertor spasticity after stroke and if either of these methods o ffers any advantages and disadvantages over the other. Twenty patients who were included in this preliminary study were randomly assigned to receive a single treatment of 400 mouse units of botulinus toxin Type A injected int o the calf muscles or to receive a tibial nerve blockade with 3 ml of 5% ph enol. A combination of subjective and objective measures were used to asses s functional change at baseline add at Weeks 2, 4, 8, and 12, At follow-up, significant improvement (P < 0.05) in the Ashworth score for dorsiflexion was observed in both groups. The change in the Ashworth score for eversion was significant in the group that received botulinus toxin Type A (P < 0.05 ) but not in the group that received phenol (P > 0.05). When those variable s were compared between the two groups, the change in the Ashworth scare at Weeks 2 and 4 was significantly better in the group that received botulinu s toxin Type A (P < 0.05) but there was not a significant difference betwee n the two groups at Weeks 8 and 12 (P > 0.05). The decrease in clonus durat ion that was detected by electromyography was significant in both groups at all visits, but the decrease in the group that received botulinus toxin Ty pe A was significantly better at Weeks 2 and 4 (P < 0.05). It is concluded that both motor point injections with botulinus toxin Type A and tibial ner ve blockade with phenol are effective in plantar flexor spasticity, but the changes were more significant in the group that received botulinus toxin T ype A at Weeks 2 and 4, whereas there was not a significant difference betw een the two groups at Weeks 8 and 12. Future research should explore the lo ng-term effect of these two treatment modalities.