title: Botulinum toxin A: a new option for treatment of drooling in children with cerebral palsy. Presentation of a case series.
abstract: Drooling beyond the age of 4 years is pathological, particularly if it occurs in children with neurological and developmental impairment and disability. Considering the therapeutic spectrum of botulinum toxin A and in view of the innervation of the salivary glands, we postulated that intraglandular injections into the submandibular glands with botulinum toxin A could reduce the secretion of saliva and consequently decrease drooling. Three patients with cerebral palsy and severe drooling were selected and evaluated over a 4-month period. Under ultrasound guidance, one dose of botulinum toxin A was injected bilaterally into the submandibular glands. Saliva secretion was measured at baseline and repeated four times during the following 4 months. In the three patients, maximal salivary flow rate of the sublingual and submandibular glands was reduced by 51% to 63%. The time of the maximal effect differed among the three children. The parents reported a satisfactory reduction of drooling throughout the whole study period. No objectionable disturbances of oral functions were observed. There was mild transient thickening of saliva in one of the patients.
  
  
  CONCLUSIONS
  The application of botulinum toxin A to the submandibular gland is a promising technique to reduce salivary flow rate and probably an alternative in the treatment of drooling in children with cerebral palsy.
authors.affiliation: Department of Rehabilitation, University Hospital Nijmegen, The Netherlands. P.Jongerius@policss1.azn.nl
authors.forename: P H
authors.initials: PH
authors.lastname: Jongerius
authors.forename: J J
authors.initials: JJ
authors.lastname: Rotteveel
authors.forename: F
authors.initials: F
authors.lastname: van den Hoogen
authors.forename: F
authors.initials: F
authors.lastname: Joosten
authors.forename: K
authors.initials: K
authors.lastname: van Hulst
authors.forename: F J
authors.initials: FJ
authors.lastname: Gabreëls
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D012472:Salivation / Q000187:drug effects; D012798:Sialorrhea / Q000188:drug therapy* / Q000209:etiology
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A