title: Salivary gland botulinum toxin injections for drooling in children with cerebral palsy and neurodevelopmental disability: a systematic review.
abstract: OBJECTIVE
  The aim of this paper was to systematically review the efficacy and safety of botulinum toxin (BoNT) injections to the salivary glands to treat drooling in children with cerebral palsy and neurodevelopmental disability.
  
  
  METHODS
  A systematic search of The Cochrane Central Register of Controlled Trials, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, and the Physiotherapy Evidence Database (PEDro) was conducted (up to 1 October 2011). Data sources included published randomized controlled trials (RCTs) and prospective studies.
  
  
  RESULTS
  Sixteen studies met inclusion criteria. Three outcome measures support the effectiveness of BoNT for drooling. One RCT found an almost 30% reduction in the impact of drooling on patients' lives, as measured by the Drooling Impact Scale (mean difference -27.45; 95% confidence interval [CI] -35.28 to -19.62). There were sufficient data to pool results on one outcome measure, the Drooling Frequency and Severity Scale, which supports this result (mean difference -2.71; 95% CI -4.82 to -0.60; p<0.001). There was a significant reduction in the observed number of bibs required per day. The incidence of adverse events ranged from 2 to 41%, but was inconsistently reported. One trial was terminated early because of adverse events.
  
  
  CONCLUSIONS
  BoNT is an effective, temporary treatment for sialorrhoea in children with cerebral palsy. Benefits need to be weighed against the potential for serious adverse events. More studies are needed to address the safety of BoNT and to compare BoNT with other treatment options for drooling.
authors.affiliation: Queensland Paediatric Rehabilitation Service, The Royal Children's Hospital, Herston, Brisbane, Australia. katerodwell@hotmail.com
authors.forename: Kate
authors.initials: K
authors.lastname: Rodwell
authors.forename: Priya
authors.initials: P
authors.lastname: Edwards
authors.forename: Robert S
authors.initials: RS
authors.lastname: Ware
authors.forename: Roslyn
authors.initials: R
authors.lastname: Boyd
mesh_terms: D001905:Botulinum Toxins / Q000008:administration & dosage*; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002658:Developmental Disabilities / Q000150:complications*; D006801:Humans; D012469:Salivary Glands / Q000187:drug effects*; D012798:Sialorrhea / Q000188:drug therapy* / Q000209:etiology
chemical_list: D001905:Botulinum Toxins