Botulinum toxin A: a new option for treatment of drooling in children with cerebral palsy. Presentation of a case series.
SourceEuropean Journal of Pediatrics, 160, 8, (2001), pp. 509--12
Article / Letter to editor
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European Journal of Pediatrics
SubjectDisturbances of cerebral development in the young child.; Hearing and Communication Disorders; Pathophysiology of Brain and Behaviour; Cerebrale ontwikkelingsstoornissen bij het jonge kind; Gehoor en communicatie; Pathofysiologie van Hersenen en Gedrag
Drooling beyond the age of 4 years is pathological, particularly if it occurs in children with neurological and developmental impairment and disability. Considering the therapeutic spectrum of botulinum toxin A and in view of the innervation of the salivary glands, we postulated that intraglandular injections into the submandibular glands with botulinum toxin A could reduce the secretion of saliva and consequently decrease drooling. Three patients with cerebral palsy and severe drooling were selected and evaluated over a 4-month period. Under ultrasound guidance, one dose of botulinum toxin A was injected bilaterally into the submandibular glands. Saliva secretion was measured at baseline and repeated four times during the following 4 months. In the three patients, maximal salivary flow rate of the sublingual and submandibular glands was reduced by 51% to 63%. The time of the maximal effect differed among the three children. The parents reported a satisfactory reduction of drooling throughout the whole study period. No objectionable disturbances of oral functions were observed. There was mild transient thickening of saliva in one of the patients. CONCLUSION: The application of botulinum toxin A to the submandibular gland is a promising technique to reduce salivary flow rate and probably an alternative in the treatment of drooling in children with cerebral palsy.
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