Document Type : original article

Authors

1 Department of Pediatrics, School of medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Pediatric Neurology Ward, Mashhad University of Medical Sciences

3 Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

4 Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

5 Assistant Professor of Pediatric. Mashhad University of Medical Sciences, Mashhad, Iran.

6 Clinical Research Development Center, Akbar Hospital, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran

7 Assistant Prof of Pediatric Pulmonology, Mashhad University of Medical Sciences

Abstract

Background: Cerebral palsy stands as the main cause of mobility disability in childhood, and the accompanying sialorrhea exacerbates health and psychological issues for both the child and the family. We aimed to assess the effect of botulinum toxin type A on reducing sialorrhea in children with cerebral palsy.
Methods: This self-controlled clinical trial was executed among children afflicted with cerebral palsy. The Teacher Drooling Scale was used as the data collection tool. The intervention involved the administration of botulinum toxin A, with a dosage ranging from 30 to 50 units in each parotid gland, skillfully guided by a radiologist using ultrasound. Sialorrhea scores were compared before and after the injection.
Results: Our study included 21 children with cerebral palsy and sialorrhea. After the two post-injection weeks, a noteworthy drop was observed in the sialorrhea score (4.10±0.831) compared to the pre-injection score (4.71±0.463). The sialorrhea score until the ninth month after injection (1.121±3.43) was still significantly lower than the score before injection.
Conclusion: The injection of botulinum toxin A emerges as a potent medication, significantly curtailing the drooling among patients with cerebral palsy. This finding can be used to prevent aspiration pneumonia and reduce social and psychological complications in this population.

Keywords

Law M, Darrah J, Pollock N, Rosenbaum P, Russell D, Walter SD, Petrenchik T, Wilson B, Wright V. Focus on function–a randomized controlled trial comparing two rehabilitation interventions for young children with cerebral palsy. BMC pediatrics. 2007; 7(1):1-12. Dalvand H, Rassafiani M, Hosseini SA. Handling in the children with cerebral palsy: A review of ideas and practices (A literature review). Journal of Rehabilitation. 2013; 13(5):8-17. Odding E, Roebroeck ME, Stam HJ. The epidemiology of cerebral palsy: incidence, impairments and risk factors. Disability and rehabilitation. 2006; 28(4):183-91. Levitt S, Addison A. Treatment of cerebral palsy and motor delay: John Wiley & Sons; 2018. Benson J, Daugherty KK. Botulinum toxin A in the treatment of sialorrhea. Annals of Pharmacotherapy. 2007; 41(1):79-85. Lim M, Mace A, Nouraei S, Sandhu G. Botulinum toxin in the management of sialorrhoea: a systematic review. Clin Otolaryngol. 2006; 31(4):267-72. Tan EK. Botulinum toxin treatment of sialorrhea: comparing different therapeutic preparations. European Journal of Neurology. 2006; 13:60-4. Dias BLS, Fernandes AR, Maia Filho HdS. Sialorrhea in children with cerebral palsy. Jornal de pediatria. 2016; 92:549-58. Hung S-A, Liao C-L, Lin W-P, Hsu JC, Guo Y-H, Lin Y-C. Botulinum toxin injections for treatment of drooling in children with cerebral palsy: A systematic review and meta-analysis. Children. 2021; 8(12):1089. Vashishta R, Nguyen SA, White DR, Gillespie MB. Botulinum toxin for the treatment of sialorrhea: a meta-analysis. Otolaryngology--Head and Neck Surgery. 2013; 148(2):191-6. Wilken B, Aslami B, Backes H. Successful treatment of drooling in children with neurological disorders with botulinum toxin A or B. Neuropediatrics. 2008; 39(04):200-4. Basciani M, Di Rienzo F, Fontana A, Copetti M, Pellegrini F, Intiso D. Botulinum toxin type B for sialorrhoea in children with cerebral palsy: a randomized trial comparing three doses. Developmental Medicine & Child Neurology. 2011; 53(6):559-64. Alrefai AH, Aburahma SK, Khader YS. Treatment of sialorrhea in children with cerebral palsy: a double-blind placebo controlled trial. Clinical neurology and neurosurgery. 2009; 111(1):79-82. Rodwell K, Edwards P, Ware RS, Boyd R. Salivary gland botulinum toxin injections for drooling in children with cerebral palsy and neurodevelopmental disability: a systematic review. Developmental Medicine & Child Neurology. 2012; 54(11):977-87. Sforza E, Onesimo R, Leoni C, Giorgio V, Proli F, Notaro F, Kuczynska EM, Cerchiari A, Selicorni A, Rigante D, Zampino G. Drooling outcome measures in pediatric disability: a systematic review. European Journal of Pediatrics. 2022; 181(7):2575-92. Jongerius PH, Rotteveel JJ, van den Hoogen F, Joosten F, van Hulst K, Gabreëls FJ. Botulinum toxin A: a new option for treatment of drooling in children with cerebral palsy. Presentation of a case series. European journal of pediatrics. 2001; 160:509-12. Bothwell JE, Clarke K, Dooley JM, Gordon KE, Anderson R, Wood EP, Camfield CS, Camfield PR. Botulinum toxin A as a treatment for excessive drooling in children. Pediatric neurology. 2002; 27(1):18-22. Ellies M, Rohrbach-Volland S, Arglebe C, Wilken B, Laskawi R, Hanefeld F. Successful management of drooling with botulinum toxin A in neurologically disabled children. Neuropediatrics. 2002; 33(06):327-30. Jost WH, Bäumer T, Laskawi R, Slawek J, Spittau B, Steffen A, Winterholler M, Bavikatte G. Therapy of sialorrhea with botulinum neurotoxin. Neurology and therapy. 2019; 8:273-88.