Ultrasound Guided Intraglandular Injections of Botulinum Toxin Type A: a New Option for Treatment of Sialorrhoea in Childern with Cerebral Palsy
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Background: Sialorrhoea (excessive drooling) is an important clinical, social, and emotional issue for people with severe neurological disease such as cerebral palsy in childhood and parkinson's disease or amyotrophic lateral sclerosis (ALS) in adults, In the neurologically impaired child, excessive drooling, or sialorrhoea, can add significantly to the management requirements of an individual whose care already demands an enormous amount of time and effort. Over the last several years, botulinum toxin type A (BTX-A) has gained widespread use for the management of focal spasticity in children with cerebral palsy. The application of BTX-A to treat drooling is still experimental and subject to research. Because of the pharmacological properties of BTX-A, it has been postulated that BTX-A might reduce salivary flow from the salivary glands. Objectives: To study the safety and efficacy of ultrasound guided botulinum toxin type A injections into the submandibular glands for treatment of sialorrhoea in children with cerebral palsy. Material and Methods: Twenty children with cerebral palsy and sialorrhoea were included in this study (13 males & 7 females). Salivary flow was measured under standardized conditions. Under ultrasound guidance, one dose of BTX-A (BOTOX®) was injected bilaterally into the submandibular glands with the patients under general anesthesia as an outpatient's procedure or during a short stay at the daytime care unit. All cases were evaluated with salivary flow measurement before injection (baseline) and repeated at one week and 24 weeks after injection. Result(s): There were a statistical significant difference in severity, frequency of drooling and amount of salivation as regarding the effects of ultrasound guided botulinum toxin type A injection into submandibular glands for the treatment of sialorrhoea. Of the 20 patients treated, seventeen (85%) reported a subjective reduction in salivation one week and 24 weeks after injection. The parents reported a satisfactory reduction of drooling throughout the whole study period. No serious adverse events occurred and no procedure related complications were reported.