title: Thickened saliva after effective management of drooling with botulinum toxin A.
abstract: OBJECTIVE
  The aim of this study was to evaluate the rheological properties of saliva after submandibular botulinum toxin type A (BoNT-A) injections.
  
  
  METHODS
  We enrolled 15 children (11 males and six females; age range 3-17 y, mean age 9 y 10 mo) diagnosed with spastic (n=9) or dyskinetic (n=6) quadriplegic cerebral palsy (CP); Gross Motor Function Classification System level IV or V; and two children with intellectual disability (IQ<70) who experienced moderate to severe drooling. Salivary flow rate and drooling quotient were measured at baseline and at different times after BoNT-A injections up to 24 weeks. The mucin concentration of saliva was analysed before and after BoNT-A treatment.
  
  
  RESULTS
  Both submandibular salivary flow rate (baseline 0.38 mL/min; 24 wks after injection 0.26 mL/min) and drooling quotient (baseline 42.5%; 24 wks 28.80%) were substantially reduced, with a concomitant increase in mucin concentration within 8 weeks after BoNT-A injection (from 0.612 to 1.830 U/mL). The parents of nine children observed thickened saliva. Swallowing and chewing were problematic in seven children. Two of these children needed treatment with mucolytics because of pooling of thickened saliva in the throat.
  
  
  CONCLUSIONS
  When making decisions about the use of BoNT-A, the risk of problems with masticatory and swallowing functions as a result of thickening of saliva after BoNT-A treatment should be taken into account.
authors.affiliation: Department of Paediatric Neurology, Radboud University Nijmegen Medical Centre/Donders Institute for Brain, Cognition and Behaviour, the Netherlands. c.erasmus@cukz.umcn.nl
authors.forename: Corrie E
authors.initials: CE
authors.lastname: Erasmus
authors.forename: Karen
authors.initials: K
authors.lastname: Van Hulst
authors.forename: Frank Ja
authors.initials: FJ
authors.lastname: Van Den Hoogen
authors.forename: Jacques
authors.initials: J
authors.lastname: Van Limbeek
authors.forename: Nel
authors.initials: N
authors.lastname: Roeleveld
authors.forename: Enno Ci
authors.initials: EC
authors.lastname: Veerman
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Rotteveel
authors.forename: Peter H
authors.initials: PH
authors.lastname: Jongerius
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000188:drug therapy / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003679:Deglutition / Q000187:drug effects; D005100:Expectorants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008409:Mastication / Q000187:drug effects; D009077:Mucins / Q000032:analysis; D018373:Peripheral Nervous System Agents / Q000009:adverse effects / Q000627:therapeutic use*; D012463:Saliva / Q000737:chemistry / Q000187:drug effects* / Q000378:metabolism; D012798:Sialorrhea / Q000188:drug therapy*; D013363:Submandibular Gland / Q000187:drug effects / Q000378:metabolism; D013997:Time Factors; D014783:Viscosity
chemical_list: D005100:Expectorants; D009077:Mucins; D018373:Peripheral Nervous System Agents; D019274:Botulinum Toxins, Type A