Objective: To evaluate the benefits of treatment of drooling with Botulinum Toxin Type A (AbobotulinumtoxinA) in patients with cerebral palsy.

Background: Patients with cerebral palsy present many factors that predispose to sialorrhea, such as difficulty forming bolus, reduced lip seal, inability to sucking and chewing, poor neck control, impaired tongue movement, decreased oral sensitivity, dental malocclusion, incoordination of orofacial muscles and airway obstruction. This condition can significantly impair life quality and it is a potential contributor to caregiver burden. Considering this, many treatment methods for sialorrhea have been described, and the use of Botulinum Toxin has shown to be an effective strategy for managing this condition

Methods: This was an interventional, prospective-longitudinal study. Patients affected with cerebral palsy and who had sialorrhea were included in this study. AbobotulinumtoxinA (Dysport), 500 units, was injected bilaterally in the parotid and submandibular glands. Application was guided by ultrasonography and 60 units were injected in each side (40 units in the parotid glands and 20 in the submandibular glands). Outcome evaluations were analyzed at 0, 15, 60 and 90 days, which corresponds to the times T0, T1, T2 and T3, respectively. Patients were followed up at Botulinum Toxin Application Institute, Pará, Brazil. This study was approved by the Ethics Committee on Human Research (CAAE:10718312.10000.0018). Descriptive statistics were used to characterize the results. The statistical test used Kruskal-Wallis and statistical post-hoc Dunn’s test. The significance level was 5% (p<0.05).

Results: Twenty patients were evaluated; 55% were female and 45% male. Participants age ranged between 5 and 29 years. Of the four scales used to assess reduced salivation (frequency, severity, overproduction and number of wipes or bibs used per day), positive results (p<0.05) were observed in T1 for the overproduction and number of wipes used in one day, and the best results occurred in T2 and T3 for all scales. Adverse reactions included thick saliva (30%), pain and edema (25%), and mild redness (10%) at the application site. The main disadvantage was the toxin’s temporary effect, with the need for a new application in 65% of patients within 90 days.

Conclusions: This treatment was an efficient strategy for management of sialorrhea after application in 95% of our cases. Due to good clinical results, such therapy may be an effective and safe alternative for patients with cerebral palsy.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-botulinum-toxin-treatment-for-sialorrhea-in-patients-with-cerebral-palsy/