title: [The efficacy of botulinum toxin-A in the treatment of hypersalivation in children with cerebral palsy].
abstract: OBJECTIVE
  We evaluated the efficacy of botulinum toxin A (BTX-A) injection into the submandibular salivary gland to decrease hypersalivation in children with cerebral palsy (CP).
  
  
  METHODS
  Three children (1 girl, 2 boys; mean age 10; range 7 to 13 years) with CP received BTX-A injections. Due to hypersalivation, two patients dirtied 50 napkins and 5-6 pieces of clothes daily, and one patient dirtied 100 napkins and 8-9 pieces of clothes. The severity of hypersalivation was assessed using the drool rating scale. Injections were performed in the submandibular gland under ultrasound localization and under local anesthesia. The amount of saliva flow at the mouth two hours after the meals and in a duration of 30 minutes was assessed seven times: before the first injection and at different intervals after injections up to 12 weeks. The dose of BTX-A was increased from 5 to 20 units per gland in two patients, while one patient received a standard dose of 20 units. At least 50% reduction in saliva secretion at the end of three months was accepted as a successful outcome.
  
  
  RESULTS
  Lower doses of BTX-A were not effective to provide the desired amount of reduction in saliva in two patients. However, application of 20 units resulted in a satisfactory decrease in all the patients.
  
  
  CONCLUSIONS
  In selected patients and with appropriate doses, ultrasound-guided BTX-A injections may improve hypersalivation in patients with CP.
authors.affiliation: Department of Otolaryngology, Medicine Faculty of Harran University, Sanliurfa, Turkey. necat66@yahoo.com
authors.forename: Necat
authors.initials: N
authors.lastname: Alataş
authors.forename: Pelin
authors.initials: P
authors.lastname: Yazgan
authors.forename: Adil
authors.initials: A
authors.lastname: Oztürk
authors.forename: Imran
authors.initials: I
authors.lastname: San
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002547:Cerebral Palsy; D002648:Child; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D012798:Sialorrhea / Q000188:drug therapy* / Q000473:pathology; D013363:Submandibular Gland; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A