Q: My son is 1 year 8 months old. He was a preterm baby (30 weeks, birth weight 1.34 kg.). He was diagnosed with spastic cerebral palsy at the age of 5 months. We have been giving him physiotherapy from that period. Till 18 months, he was given Liofen 10 mg tablets and now he is on Pacitane 2 mg tablets. He has spasm in his lower limbs. His hands are fine. He can hold a pencil properly. He can crawl and stand with support. In the beginning he used to stand on his toes and now he can keep his foot properly, but he is bending on his knees. He can’t stand independently. Whenever he walks with support he is turning his left leg towards the right. What are the chances of improvement if we try Botox injections?

A:I recognise that your child has cerebral palsy of the diplegic kind; meaning the legs are more affected than the arms. There is spasticity which is more in the hamstrings because he has a crouched gait. It is also possible that his calf muscles are tight too. I would recommend that he be seen by a Paediatric Neurologist/Orthopaedic surgeon. Botox is beneficial and the earlier that it is injected (2-4 yrs), the better. What one has to see is that if the contractures or tightness is fixed (permanent, in lay term) or not. If not fixed then Botox injections can be administered with subsequent serial casting. The effect of Botox lasts 6-8 months, and in some patients it may have to be repeated. Barring the cost, Botox has no appreciable side effects.