title: What could predict effectiveness of Botulinum Toxin to treat drooling: a search for evidence of discriminatory factors on the level of body functions or structures.
abstract: BACKGROUND
  The treatment of drooling is important to families that experience the daily impact and research to elucidate clinical factors that play a role in the outcome of drooling treatment should be encouraged.
  
  
  OBJECTIVE
  To define clinical factors that influence therapy outcome of submandibular Botulinum Toxin (BoNT-A) injections for drooling.
  
  
  METHODS
  Prospectively collected data of 128 children with cerebral palsy were evaluated; 80 spastic and 48 dyskinetic movement disorder, mostly Gross Motor Function Classification System III and higher; over 70% had an IQ <70. In addition, 23 fully ambulant children with exclusively intellectual disability were treated for drooling by ultrasound-guided injections of BoNT-A into the submandibular glands. Salivary flow rates and drooling quotients were measured at baseline and at 8 weeks after injection. Extensive information about the oral motor performance was gathered. Successful clinical response was defined as a 50% reduction of the baseline Drooling Quotient; 85 children were responsive to BoNT-A and 66 children unresponsive.
  
  
  RESULTS
  Five nominated clinical factors that possibly could influence saliva reduction (head position, lip seal, voluntary control over the tongue, control of voluntary movement functions, and mental age) did not influence the responsiveness to BoNT-A.
  
  
  CONCLUSIONS
  Other variables need to be considered to predict the outcome of BoNT-A treatment. This article describes the first attempt to reveal the contribution of body functions and structures to the outcome of BoNT-A submandibular injections.
authors.affiliation: Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Paediatric Neurology, Nijmegen, The Netherlands. c.erasmus@neuro.umcn.nl
authors.forename: Corrie E
authors.initials: CE
authors.lastname: Erasmus
authors.forename: Karen
authors.initials: K
authors.lastname: van Hulst
authors.forename: Arthur R T
authors.initials: AR
authors.lastname: Scheffer
authors.forename: Jacques
authors.initials: J
authors.lastname: van Limbeek
authors.forename: Frank J A
authors.initials: FJ
authors.lastname: van den Hoogen
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Rotteveel
authors.forename: Peter H
authors.initials: PH
authors.lastname: Jongerius
mesh_terms: D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015415:Biomarkers; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000209:etiology; D004401:Dysarthria / Q000209:etiology; D005260:Female; D006801:Humans; D007267:Injections; D008607:Intellectual Disability / Q000150:complications; D008297:Male; D009055:Mouth / Q000502:physiology; D010306:Parotid Gland / Q000378:metabolism; D011237:Predictive Value of Tests; D011597:Psychomotor Performance / Q000502:physiology; D012472:Salivation / Q000502:physiology; D012798:Sialorrhea / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013363:Submandibular Gland / Q000000981:diagnostic imaging / Q000378:metabolism; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D018726:Anti-Dyskinesia Agents; D015415:Biomarkers; D001905:Botulinum Toxins