Repeated onabotulinum neurotoxin A injections for drooling in children with neurodisability

Abstract

NabNeutralizing antibodies VAS Visual analogue scale AIM To evaluate the effect of repeated onabotulinum neurotoxin A injections for the treatment of drooling in children with neurodisabilities.METHOD This was a retrospective cohort study, in which the first, second, and third onabotulinum neurotoxin A injection were compared within children treated between 2000 and 2020. Primary outcomes included drooling quotient, visual analogue scale (VAS), and treatment success defined as ≥50% reduction in drooling quotient and/or VAS 8 weeks after treatment. Each outcome was obtained at baseline and 8 weeks posttreatment.RESULTS Seventy-seven children were included (mean age at first injection: 8y 3mo, SD 3y 7mo, range 3-17y; 44 males, 33 females; 51.9% with cerebral palsy, 45.5% wheelchair-bound).The objective (drooling quotient) and subjective (VAS) effect after the second injection was lower compared to the first injection. The third injection showed less objective and significantly less subjective effect compared to the first injection. An overall success rate of 74.0%, 41.6%, and 45.8% were found for the first, second, and third injection respectively.INTERPRETATION Although onabotulinum neurotoxin A remained effective throughout the entire treatment course, there is less effect of subsequent onabotulinum neurotoxin A injections compared to the first. Although there might be a loss of effect after repeated injections, there is continued improvement for most children.

Current Aspects of Treatment Options of Chronic Sialorrhea in Children

“…Non-pharmacological therapy options are speech-, physio- and orofacial therapy. Pharmacological options to treat sialorrhea are botulinum A/B intra-glandular injections (level A evidence) and anticholinergic treatment like glycopyrronium bromide or transdermal patch therapy with scopolamine (level B evidence) [ 9 , 13 , 15 , 18 - 20 , 28 , 29 , 31 , 32 , 34 , 35 , 38 , 39 , 43 , 44 , 47 ]. Useful drug therapies for acute hypersalivation include various application forms of glycopyrrolate, of which glycopyrronium bromide received a pan-European pediatric use authorization (PUMA) in 2017 for the symptomatic treatment of hypersalivation in children and adolescents [ 5 ].…”

“…Useful drug therapies for acute hypersalivation include various application forms of glycopyrrolate, of which glycopyrronium bromide received a pan-European pediatric use authorization (PUMA) in 2017 for the symptomatic treatment of hypersalivation in children and adolescents [ 5 ]. In recent years, botulinum toxin injections into the major salivary glands have been shown to be an effective and safe treatment modality with long-lasting saliva reduction [ 9 , 13 , 15 , 18 - 20 , 28 , 29 , 31 , 32 , 34 , 35 , 38 , 39 , 43 , 44 , 47 ]. All anticholinergic medications induce typical side effects like dry mouth, constipation, urinary retention and reduced bronchial secretion.…”

The Masticatory Structure and Function in Children with Cerebral Palsy—A Pilot Study

“…Nowadays, the medical field proposes various treatments, such as botulinum toxin injections, surgical procedures, laser photocoagulation, pharmacotherapy, and acupuncture [ 2 , 5 , 10 , 11 , 12 , 13 , 14 ]. It is necessary to include safe complementary therapies, which involve interdisciplinary medical teams.…”

Making decisions about surgical intervention for drooling in children with neurodisability

“…With the use of botulinum neurotoxin A (BoNT-A), we support the findings of initial improvement, with subsequent injections becoming less effective. 2 The rare complication of leakage of BoNT-A, out of the salivary glands and into the surrounding muscles may lead to a temporary worsening of oropharyngeal dysphagia, which is not always associated with level of physical impairment. We use ultrasound to guide the needle into the gland to minimize this complication.…”