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. |
