Use of botulinum neurotoxin A in uncontrolled salivation in children with cerebral palsy: a pilot study

This study investigated the safety and efficacy of botulinum neurotoxin type-A (BNT-A) injections into the salivary glands for treatment of sialorrhea in children with cerebral palsy (CP) and assessed the clinical factors that affect treatment outcome. The parotid and submandibular glands of nine CP patients were injected with BNT-A 1.4 U/kg in each parotid gland, and 0.6 U/kg in each submandibular gland. All children had neurological disorders. Gross motor function classification system levels ranged from I to V. All children had moderate to severe intellectual disability. A telephone interview with one parent determined response to treatment. Drooling intensity and frequency were measured with the drooling severity and frequency scale. After BNT-A treatment, the patients were followed up for 6 months using self-assessed rating scales for drooling intensity, discomfort and treatment effect (drooling impact scale). All parents reported an improvement in sialorrhea in the first week. Drooling was very intensive at baseline, and moderate 2 weeks after treatment. Maximum response occurred at 2-8 weeks. The use of BNT-A in uncontrolled salivation in children with CP can be considered acceptable and effective. Malocclusion and anterior salivation are closely related clinical characteristics and should be taken into account when planning treatment.