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Does motor performance matter in botulinum toxin efficacy for drooling?

Corrie E Erasmus1, Arthur R T Scheffer, Karen van Hulst

  • 1Department of Pediatric Neurology, Radboud University Nijmegen Medical Centre/Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands. c.erasmus@neuro.umcn.nl

Pediatric Neurology
|July 19, 2011
PubMed
Summary

Botulinum toxin injections effectively reduced drooling in children with cerebral palsy or mental disability. However, predicting treatment response remains challenging, as increased parotid flow may indicate therapy failure.

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Area of Science:

  • Neurology
  • Pediatrics
  • Pharmacology

Background:

  • Drooling, or excessive salivation, is a common challenge in children with cerebral palsy (CP) and mental disabilities.
  • Botulinum toxin injections targeting submandibular glands are used to manage this condition.
  • Predicting treatment efficacy remains an area of investigation.

Purpose of the Study:

  • To identify factors influencing the therapeutic outcomes of submandibular botulinum toxin injections for drooling in children.
  • To explore the relationship between different cerebral palsy subtypes and treatment response.
  • To investigate the role of salivary flow changes in treatment success or failure.

Main Methods:

  • Prospective evaluation of 80 spastic and 48 dyskinetic children with CP, and 23 children with mental disability only.
  • Assessment of salivary flow (submandibular and parotid) and Drooling Quotient at baseline and 8 weeks post-injection.
  • Analysis of treatment response based on changes in salivary parameters and clinical outcomes.

Main Results:

  • Botulinum toxin treatment led to decreased Drooling Quotient and submandibular flow in all participants.
  • Ninety-three children responded to the treatment, with decreased submandibular flow correlating with reduced parotid flow.
  • Non-responders exhibited increased parotid flow, suggesting a potential marker for therapy failure, though its exact role is unclear.

Conclusions:

  • Submandibular botulinum toxin injections are generally safe and effective in reducing drooling and submandibular salivary flow in children with CP and mental disabilities.
  • Increased parotid flow post-injection may indicate a lack of therapeutic response.
  • Current data do not allow for prediction of individual patient response to botulinum toxin therapy for drooling.