The impact of botulinum toxin type A in the treatment of drooling in children with cerebral palsy secondary to Congenital Zika Syndrome: an observational study

Abstract

Objective:The main aim of this study was to determine the impact of botulinum toxin A (BTX-A) on severity and frequency of drooling in children with Cerebral Palsy (CP) secondary to Congenital Zika Syndrome (CZS). Methods: This is a prospective longitudinal observational study including 23 children who received bilateral injections of BTX in the parotid and submandibular glands. The Thomas-Stonell & Greenberg Drooling Severity and Frequency Scale was applied by a multidisciplinary team including Speech, Language and Hearing professionals. The Global Impression of Improvement (GII) Scale was also applied to assess parents' subjective perceptions of therapeutic response. Swallowing was assessed using Doppler ultrasonography. Univariate logistic regression was used to analyse differences between responders and non-responders. Results: Participant age varied from 27 to 38 months (mean 31.78, SD = 2.61) all presented with Gross Motor Function Classification System (GMFCS) V. Drooling Severity and Frequency Scale scores ranged from 7 to 9 points (median = 9) prior to BTX administration and from 4 to 6 (median = 6) after. Pre-and post-treatment reduction in drooling severity occurred (Z = −3.746; p < 0.001). No cases of drooling worsening were reported. Only two subjects presented adverse effects attributed to BTX administration. Correlation was only confirmed with GII. Discussion: This article presents the safe and positive impact of BTX-A administration guided by anatomical references described in the literature, even on children with microcephaly. Further studies are needed to facilitate the use of Doppler ultrasonography as a tool to characterize changes in sensory processing and motor response following intraoral input in children with CP.

Effect of Hospital-Family Rehabilitation Intervention on Walking Function and Lower Limb Surface Electromyography in Children with Cerebral Palsy

“…For example, the United Kingdom, as a country with relatively perfect social security, has set up special schools for children with CP, and professional therapists provide services every month [ 29 ]. A treatment center for CP has been established in the capital of Denmark, focusing on the assistance of children [ 30 , 31 ]. Family rehabilitation in the United States and Britain requires a family health care model that combines hospitals and families, emphasizing the treatment of the family as a unit [ 32 ].…”

Onabotulinum Toxin A (BoNT‐A) for Drooling in Children: A Systematic Review and Meta‐Analysis

“…It was observed that a few patients had side effects after injection, but most of them had mild to moderate transient adverse events. In this systematic review, six studies reported dysphagia as common adverse effects after the first injection, 12,18,19,22,28,31 one study reported speech problems. 22 All of these effects are fully reversible as the effect of botulinum toxin is transient.…”

“…Thus, the qualitative and quantitative analysis was conducted with eight clinical studies involving BoNT-A as the treatment of drooling in children. [12][13][14][15][16][17][18][19]…”

“…Two studies mentioned the injection of BoNT-A only in the bilateral parotid gland, 14,20 whereas the majority reported injection in both bilateral parotid and bilateral submandibular gland. 12,13,[15][16][17]19,[21][22][23][24][25][26][27] One study reported unilateral parotid gland and bilateral submandibular gland, 18 whereas another study mentioned bilateral gland and unilateral submandibular gland. 28 There was variation in doses of BoNT-A ranges from 60 U to 100 U and average dose was used as 1.1 unit/kg/gland.…”

“…Six studies reported dysphagia. 12,18,19,22,[28][29][30][31] One study reported transient increase in saliva after first injection after one week. 14 Thickening of saliva was found in two studies.…”