Onabotulinum Toxin A Injections Into the Salivary Glands for Spinal Muscle Atrophy Type I

Shoval, Hannah A.; Antelis, Esther; Hillman, Andrew; Wei, Xiaofang; Tan, Patricia Z.; Alejandro, Ruth E.; Kim, Heakyung

doi:10.1097/phm.0000000000000989

Cited by 10 publications

(9 citation statements)

References 21 publications

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“…Of the 31 total studies, 15 studies evaluated drooling in children with cerebral palsy specifically or combination with an unspecified intellectual disability, 7 , 13 , 16 - 28 14 studies evaluated drooling in patients with a variety of neurologic or neurodevelopmental impairments, 10 , 14 , 29 - 40 1 study looked at hypersalivation in spinal muscle atrophy type I, 41 and 1 study involved a case series with Rett syndrome. 42 The age range was 1 month old to 21 years old.…”

Section: Resultsmentioning

confidence: 99%

“… 42 The total injection dose was weight-dependent in 8 studies, with children weighing <15 kg receiving 30 total units, 15 to 25 kg receiving 40 total units, and >25 kg receiving 50 total units, on average. 7 , 20 , 24 , 25 , 31 , 33 , 37 , 41 Bernardo et al 42 conducted the only study that used Xeomin ® for injections. The authors injected bilateral submandibular and parotid glands with a total dose of 150 units and found a statistically significant reduction in sialorrhea, with no adverse effects reported.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 14 studies evaluated 2-gland injections (either parotid or submandibular glands bilaterally), 7,13,14,[16][17][18][19][20][21][29][30][31][32][33] and 17 studies evaluated 4-gland injections (bilateral parotid and submandibular glands). 10,[22][23][24][25][26][27][28][34][35][36][37][38][39][40][41][42] The neurotoxin utilized in 30 studies was onabotulinumtoxinA (Botox ® , Allergen), and 1 study evaluated incobotulinumtoxinA (Xeomin ® , Merz Aesthetics). 42 The total injection dose was weight-dependent in 8 studies, with children weighing <15 kg receiving 30 total units, 15 to 25 kg receiving 40 total units, and >25 kg receiving 50 total units, on average.…”

Section: Dosing Of Bont-amentioning

confidence: 99%

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Botulinum Toxin A in the Management of Pediatric Sialorrhea: A Systematic Review

Heikel

Patel

Ziai

et al. 2022

Ann Otol Rhinol Laryngol

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Objective: Botulinum toxin A is known to be effective and safe in managing sialorrhea in pediatric patients; however, there is no consensus on a protocol for optimal injection sites and appropriate dosing for injection. Methods: This review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. PubMed, EMBASE, and other databases were queried to identify articles that evaluated botulinum toxin type A for the treatment of sialorrhea in the pediatric population. A total of 405 studies were identified. After applying inclusion and exclusion criteria, 31 articles were included for review. Results: A total of 14 studies evaluated 2-gland injections, and 17 studies evaluated 4-gland injections. Of the 31 studies included, one study assessed incobotulinumtoxinA (Xeomin®) the remaining all used onabotulinumtoxinA (Botox®). For 2-gland injection studies, a combined total of 899 participants were reviewed, where 602 participants received 50 units into their submandibular glands, while 262 participants received 30 to 50 units. Among 4-gland injection studies, there was a combined total of 388 participants, with the most prevalent dosage utilized being 60 to 100 units in 230 participants, followed by 100 units total in 77 participants. The most common adverse event was dysphagia which resolved in nearly all cases. Three studies aimed to examine 2-gland versus 4-gland injections, with 2 of the studies concluding 4-gland injection was superior. Conclusions: The strength of evidence suggests that the dosing of 50 units total of onabotulinumtoxinA to the submandibular glands is safe and effective in the pediatric population. For 4-gland injections, bilateral submandibular and parotid gland injections of 60 to 100 units total is the safe and effective dosage. There is no substantial evidence comparing 4-gland injections to 2-gland injections, but research thus far suggests 4-gland injections to be superior. Future study is needed to evaluate incobotulinumtoxinA and abobotulinumtoxinA dosages in the pediatric population.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Dosing Of Bont-amentioning

confidence: 99%

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Botulinum Toxin A in the Management of Pediatric Sialorrhea: A Systematic Review

Heikel

Patel

Ziai

et al. 2022

Ann Otol Rhinol Laryngol

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“…Nuclear aspiration studies can detect salivary aspiration but may not be able to differentiate between excessive salivation and an anatomical defect such as a laryngeal cleft 20 . Shoval et al described an unvalidated posterior drooling scale based on the presence or absence of coughing and choking while sitting or lying down 21 . For interpreting videofluoroscopic studies, the penetration‐aspiration scale is an 8‐point scale which can be used to interpret by characterizing depth and response to airway invasion.…”

Section: Discussionmentioning

confidence: 99%

“… 20 Shoval et al described an unvalidated posterior drooling scale based on the presence or absence of coughing and choking while sitting or lying down. 21 For interpreting videofluoroscopic studies, the penetration‐aspiration scale is an 8‐point scale which can be used to interpret by characterizing depth and response to airway invasion. Borders and Brates performed a systematic review of the PAS literature in 2019 and found that studies using the PAS had poor interrater reliability and discrepancies in statistical treatment.…”

Section: Discussionmentioning

confidence: 99%

Combined laryngeal cleft injection laryngoplasty and salivary botulinum toxin for saliva aspiration

Nguyen

Ongkasuwan

Anand

et al. 2022

Laryngoscope Investig Oto

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Objectives: Children with type I laryngeal clefts and sialorrhea can have posterior drooling, aspiration of oral secretions, and respiratory complications. Laryngeal cleft injection laryngoplasty (LCIL) and salivary botulinum injections (Sal-Bot) have been used separately for short-term treatment of type I laryngeal clefts and sialorrhea. Our goal was to evaluate combined LCIL and Sal-Bot and create recommendations for further treatment based on response to initial treatment. Methods: Retrospective chart review of nine patients who underwent direct laryngoscopy and bronchoscopy with combined LCIL and Sal-Bot from 2012 to 2019. Charts were reviewed for patient characteristics, response to treatment, and pre and post-op hospitalizations. Subsequent procedures were performed depending on efficacy of initial treatments.Results: Nine patients were identified. All had pre-existing neurologic conditions, gastrostomy tubes, and a history of coughing and choking on secretions. Only one patient was able to feed orally (purees). 1 U/kg of botulinum toxin per gland was injected into each parotid and submandibular gland. The average units of botulinum toxin injected was 67 U. The mean laryngeal cleft injection volume was 0.35 cc. Subsequent treatment was based on timing of symptomatic improvement and individual patient factors. Five patients had respiratory-related hospitalizations in year preceding the procedures (median 1.5, range 1-10). Three (60%) had a reduction in respiratory-related hospitalization 1 year post procedure (median 1, range 1-3). One patient died during the follow up period due to continued chronic respiratory failure.Conclusions: This is the first study of combined laryngeal cleft injection laryngoplasty and botulinum toxin injections for patients with posterior laryngeal penetration and aspiration of oropharyngeal secretions. We highlight strategies for choosing subsequent procedures based on response to initial treatment.Level of Evidence: 4.

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Approach to the Pediatric Patient with Respiratory Complications of Neuromuscular Disease

Maniaci,

Panitch

2024

Respiratory Medicine

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Onabotulinum Toxin A Injections Into the Salivary Glands for Spinal Muscle Atrophy Type I

Abstract: Ultrasound guided BTX-A injections to the salivary glands may be a safe and effective method of decreasing drooling in patients with SMA I.

Cited by 10 publications

References 21 publications

Botulinum Toxin A in the Management of Pediatric Sialorrhea: A Systematic Review

Botulinum Toxin A in the Management of Pediatric Sialorrhea: A Systematic Review

Combined laryngeal cleft injection laryngoplasty and salivary botulinum toxin for saliva aspiration

Approach to the Pediatric Patient with Respiratory Complications of Neuromuscular Disease

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