Botulinum toxin A : a new option for treatment of drooling in children with cerebral palsy. Presentation of a case series

• Published in: European journal of pediatrics Vol. 160; no. 8; pp. 509 - 512
• Main Authors: JONGERIUS, Peter H, ROTTEVEEL, Jan J, VAN DEN HOOGEN, Frank, JOOSTEN, Frank, VAN HULST, Karen, GABREËLS, Fons J. M
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01.08.2001; Berlin Springer Nature B.V
• Subjects: Adolescent; Biological and medical sciences; Botulinum toxin; Botulinum Toxins, Type A - administration & dosage; Botulinum Toxins, Type A - therapeutic use; Cerebral palsy; Cerebral Palsy - complications; Child; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Injections, Intralesional; Male; Medical sciences; Nervous system (semeiology, syndromes); Neurology; Neuromuscular Agents - administration & dosage; Neuromuscular Agents - therapeutic use; Salivation - drug effects; Sialorrhea - drug therapy; Sialorrhea - etiology; Human; Cerebral palsy; Nervous system diseases; Enzyme; Secretion; Treatment efficiency; Submandibular gland; Metalloendopeptidases; Salivary gland; Cerebral disorder; Peptidases; Local administration; Bontoxilysin; Treatment; Central nervous system disease; Hydrolases; Child; Saliva
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s004310100784

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. 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.