Botulinum Toxin A for Treatment of Sialorrhea in Children

Khan, Waqas Ullah; Campisi, Paolo; Nadarajah, Sanjeevan; Shakur, Yaseer A; Khan, Nasir; Semenuk, Dan; McCann, Cathy; Roske, L; McConney-Ellis, Sharon; Joseph, Melissa; Parra, Dimitri A.; Amaral, João; John, Philip; Temple, Michael; Connolly, Bairbre

doi:10.1001/archoto.2010.240

Cited by 41 publications

(49 citation statements)

References 27 publications

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“…It is considered to have efficacy rates ranging from 89% to 95% when injected in both submandibular and parotid glands. BoNTs injections improve symptoms effectively but temporarily; patients usually require more than one injection for drooling control . The effect by injection varies from 6 weeks to 6 months.…”

Section: Discussionmentioning

confidence: 99%

Effect of recurrent onabotulinum toxin a injection into the salivary glands: An ultrasound measurement

2015

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Section: Discussionmentioning

confidence: 99%

Effect of recurrent onabotulinum toxin a injection into the salivary glands: An ultrasound measurement

2015

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“…Minor complication rates reported in the literature range from 0% 9,10 to 11.1% 11 for submandibular gland injection and 0% 9,10,12,13 to 18.7% 14 for submandibular and parotid gland injection. No major complications were reported for submandibular gland injection.…”

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confidence: 98%

Long-term Safety and Efficacy Data on Botulinum Toxin Type A

Chan

Liang²,

Wilson³

et al. 2013

JAMA Otolaryngol Head Neck Surg

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Objective: To evaluate the safety and efficacy data on salivary gland injection botulinum toxin type A for the treatment of sialorrhea. Design and Setting:Retrospective cohort study in a tertiary academic children's hospital. Patients:A 10-year review ( January 1, 2001, through December 31, 2010) of 69 children with sialorrhea who had undergone salivary gland injection of botulinum toxin type A.Interventions: Injection of botulinum toxin type A to the submandibular and parotid glands.Main Outcome Measures: Postinjection complications, supplemental treatments, and caregiver satisfaction.Results: A total of 69 children were included in the study (42 boys and 27 girls). The first injection was given at a mean age of 9.9 years with a mean follow-up of 3.1 years. Children underwent ultrasonography-guided 4-gland injection at a constant dosage range. The telephone survey response rate was 51%. Postinjection complications occurred in 19 patients (23 events)-14 (15 events) with minor and 5 (8 events) with major complications. Major complications included aspiration pneumonia (n=3), severe dysphagia (n=2), and loss of motor control of the head (n=3), resulting in 5 hospitalizations and 2 nasogastric tube insertions. Complications were not associated with demographic or clinical factors except for a male preponderance (P =.05). Satisfaction scores were evenly distributed among respondents. Thirty-one children (45%) required supplemental treatments: medical treatment alone (n=21), surgical treatment alone (n=2), and combined medical and surgical treatment (n=8).Conclusions: Although our complication rate is within the published range, some of the major complications had significant morbidity. A subsequent surgical rate of 15% suggests the efficacy is less than universal. Thus, botulinum toxin type A injection for sialorrhea in children is a useful tool but has safety and efficacy limitations.

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“…9 Considering the increasing use of BoNT for drooling, studies to identify possible risk factors for adverse effects on oral motor functions before treatment are urgently needed. 10 Post-intervention assessments showed that adverse effects on oral motor functions with a potential negative effect on swallowing occurred from 0% [11][12][13] up to 17.8% 6 of the cases after submandibular gland injections, and up to 33% 14 of the cases after combined submandibular/parotid gland injections. To date no major complications were identified after submandibular injections.…”

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confidence: 99%

Negative effects of submandibular botulinum neurotoxin A injections on oral motor function in children with drooling due to central nervous system disorders

Hulst

Kouwenberg

Jongerius

et al. 2016

Develop Med Child Neuro

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AIM The aims of this study were: (1) to determine the incidence and nature of adverse effects on oral motor function after first injections of botulinum neurotoxin A (BoNT-A) in submandibular glands for excessive drooling in children with central nervous system disorders; and (2) to identify independent predictors of these adverse effects.METHOD A cohort study involved 209 children (123 males, 86 females, aged 4-27y, median 8y 4mo), who received submandibular BoNT-A injections for drooling. Adverse effects were categorized into swallowing, eating, drinking, articulation, and other problems. Univariable logistic regression was used to study differences in patients with and without adverse effects. Possible predictors were identified using multivariable logistic regression.RESULTS Transient adverse effects occurred in 33% of the 209 BoNT-A treatments. Almost 80% of these were mild, versus 8.7% severe. Approximately 54% of the adverse effects spontaneously resolved within 4 weeks; 3% still existed after 32 weeks. A diagnosis of cerebral palsy, higher range of BoNT-A dosage, and a pre-treatment drooling quotient <18% were found to be independent predictors of adverse effects.INTERPRETATION Before using submandibular BoNT-A injections for drooling, potential adverse effects should be discussed. Oral motor function needs to be monitored, because existing dysphagia may be worsened. The identified clinical predictors could be helpful to optimize patient selection.Treatment with botulinum neurotoxin (BoNT) in the salivary glands is a widely accepted effective intervention for drooling in children with central nervous system (CNS) disorders. When injected into the salivary glands, BoNT inhibits the acetylcholine release at the terminal nerve endings, decreasing the secretion of saliva and diminishes drooling in the majority of patients. 1The main group of children with neurological impairments treated with BoNT injections are children with cerebral palsy (CP), a vulnerable group with a spectrum of oral motor problems (estimated 40% drooling prevalence).2-4 Drooling has a serious impact on the children's social interaction, self-esteem, and health. 5 The effectiveness of salivary gland BoNT has been studied extensively, although the debate about which glands should be injected is still going on. Several studies demonstrated that, after BoNT, drooling is significantly reduced. In Scheffer's study a clinically notable response was found in 46.6% of children. 6 The duration of this effect was approximately 2 to 6 months (median 24wks). [6][7][8] In most of these studies, botulinum neurotoxin A (BoNT-A) was used. 9Considering the increasing use of BoNT for drooling, studies to identify possible risk factors for adverse effects on oral motor functions before treatment are urgently needed. 10Post-intervention assessments showed that adverse effects on oral motor functions with a potential negative effect on swallowing occurred from 0% 11-13 up to 17.8% 6 of the cases after submandibular gland injections, and up to 33% 14 of the ...

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Botulinum Toxin A for Treatment of Sialorrhea in Children

Abstract: Ultrasonographically guided botulinum toxin A injections into the salivary glands are safe and efficacious in the management of sialorrhea in children with neurologic disorders.

Cited by 41 publications

References 27 publications

Effect of recurrent onabotulinum toxin a injection into the salivary glands: An ultrasound measurement

Effect of recurrent onabotulinum toxin a injection into the salivary glands: An ultrasound measurement

Long-term Safety and Efficacy Data on Botulinum Toxin Type A

Negative effects of submandibular botulinum neurotoxin A injections on oral motor function in children with drooling due to central nervous system disorders

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