title: Negative effects of submandibular botulinum neurotoxin A injections on oral motor function in children with drooling due to central nervous system disorders.
abstract: The aims of this study were: (1) to determine the incidence and nature of adverse effects on oral motor function after first injections of botulinum neurotoxin A (BoNT-A) in submandibular glands for excessive drooling in children with central nervous system disorders; and (2) to identify independent predictors of these adverse effects.
  
  
  
  A cohort study involved 209 children (123 males, 86 females, aged 4-27y, median 8y 4mo), who received submandibular BoNT-A injections for drooling. Adverse effects were categorized into swallowing, eating, drinking, articulation, and other problems. Univariable logistic regression was used to study differences in patients with and without adverse effects. Possible predictors were identified using multivariable logistic regression.
  
  
  
  Transient adverse effects occurred in 33% of the 209 BoNT-A treatments. Almost 80% of these were mild, versus 8.7% severe. Approximately 54% of the adverse effects spontaneously resolved within 4 weeks; 3% still existed after 32 weeks. A diagnosis of cerebral palsy, higher range of BoNT-A dosage, and a pre-treatment drooling quotient <18% were found to be independent predictors of adverse effects.
  
  
  
  Before using submandibular BoNT-A injections for drooling, potential adverse effects should be discussed. Oral motor function needs to be monitored, because existing dysphagia may be worsened. The identified clinical predictors could be helpful to optimize patient selection.
authors.affiliation: Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Karen
authors.initials: K
authors.lastname: van Hulst
authors.affiliation: Department of Neurology, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Carlyn V
authors.initials: CV
authors.lastname: Kouwenberg
authors.affiliation: Department of Rehabilitation, Rehabilitation Centre Sint Maartenskliniek, Nijmegen, The Netherlands.
authors.forename: Pieter H
authors.initials: PH
authors.lastname: Jongerius
authors.affiliation: Department of Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Ton
authors.initials: T
authors.lastname: Feuth
authors.affiliation: Department of Otorhinolaryngology, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: Franciscus J A
authors.initials: FJ
authors.lastname: van den Hoogen
authors.affiliation: Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Alexander C H
authors.initials: AC
authors.lastname: Geurts
authors.affiliation: Department of Neurology, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Corrie E
authors.initials: CE
authors.lastname: Erasmus
mesh_terms: D000293:Adolescent; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000009:adverse effects*; D002493:Central Nervous System Diseases / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009055:Mouth / Q000187:drug effects / Q000502:physiology; D009068:Movement / Q000187:drug effects; D009465:Neuromuscular Agents / Q000009:adverse effects*; D012798:Sialorrhea / Q000188:drug therapy* / Q000209:etiology*; D013363:Submandibular Gland / Q000187:drug effects / Q000502:physiology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A