Botulinum toxin A for treatment of sialorrhea in children: an effective, minimally invasive approach.
OBJECTIVE
To report (1) our experience with botulinum toxin A injections into the salivary glands of pediatric patients with sialorrhea, (2) the clinical outcomes of these interventions, and (3) the associated complication rates.


METHODS
Retrospective cohort study.


METHODS
Urban pediatric hospital and pediatric rehabilitation center.


METHODS
Forty-five neurologically impaired children.


METHODS
Patients received botulinum toxin A intrasalivary injections between January 2004 and May 2008 at the Hospital for Sick Children in Toronto, Ontario, Canada. All patients received sedation or general anesthesia for their botulinum toxin A injections, which were performed using ultrasonographic guidance.


METHODS
Posttreatment assessments included the duration of effect, patient complications, saliva consistency, caregiver willingness to repeat the treatment, caregiver satisfaction with the treatment, and caregiver overall assessment of the child's posttreatment quality of life.


RESULTS
Forty-five subjects received a total of 91 botulinum toxin A treatments. The mean (SD) duration of effect was 4.6 (5.2) months. Duration of effect (log transformed) was significantly negatively associated with saliva quantity (P = .02), and there was a positive association with both increasing age and female sex, although neither reached statistical significance (P = .08 for each). Seven of the 24 documented complications were major, according to the Society of Interventional Radiology Classification System for Complications by Outcome scale. Thirty-six of the caregivers reported that this treatment improved the child's quality of life (80%).


CONCLUSIONS
Ultrasonographically guided botulinum toxin A injections into the salivary glands are safe and efficacious in the management of sialorrhea in children with neurologic disorders.
Faculty of Medicine, University of Toronto, Ontario, Canada.
Waqas Ullah
WU
Khan
Paolo
P
Campisi
Sanjeevan
S
Nadarajah
Yaseer Abdul
YA
Shakur
Nasir
N
Khan
Dan
D
Semenuk
Cathy
C
McCann
Lisa
L
Roske
Sharon
S
McConney-Ellis
Melissa
M
Joseph
Dimitri
D
Parra
Joao
J
Amaral
Philip
P
John
Michael
M
Temple
Bairbre
B
Connolly
D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006801:Humans; D007267:Injections; D016014:Linear Models; D008297:Male; D009422:Nervous System Diseases / Q000150:complications; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009864:Ontario; D011788:Quality of Life; D012189:Retrospective Studies; D012449:Safety; D012798:Sialorrhea / Q000188:drug therapy* / Q000209:etiology; D018084:Ultrasonography, Interventional
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A