Ultrasound-Guided Botulinum Toxin Type A Salivary Gland Injection in Children for Refractory Sialorrhea: 10-Year Experience at a Large Tertiary Children's Hospital.

Abstract

BACKGROUND:

Sialorrhea is problematic for neurologically impaired children, and botulinum toxin A salivary gland injection has been reported as effective in reducing sialorrhea. This article assesses the success and safety of ultrasound-guided weight-based botulinum toxin A injection for the management of sialorrhea in children.

METHODS:

A total of 111 patients (63 males; 48 females; average age 7 years) with refractory sialorrhea were treated with ultrasound-guided botulinum toxin type A salivary gland injections (144 procedures) from July 1, 2004, to July 1, 2014, using a single weight-based protocol. Patient history, procedural records, and clinical follow-up documents were retrospectively reviewed. Clinical data were compared with reported effectiveness and complications using odds ratios.

RESULTS:

A total of 144 procedures were performed in 111 patients with refractory sialorrhea. Cerebral palsy was the most common underlying etiology for sialorrhea (29%), whereas others included encephalopathy (5%), anoxic brain injury (4%), and a variety of chromosomal anomalies (5%). There was a 100% technical success rate. Overall treatment effectiveness was 68%. Repeat injections were not associated with increased clinical success. No procedure-related deaths or major complications were identified; the minor complication rate was less than 2%.

CONCLUSIONS:

The protocol used for ultrasound-guided injection of botulinum toxin A proved to be safe and effective in children suffering from sialorrhea. Image guidance technique may lead to a reduction in rates of adverse events reported in other series. Subsequent procedures do not improve upon initial efficacy.

• Authors: Matthew P Lungren, Sarah Halula, Sarah Coyne, Douglas Sidell, John M Racadio, Manish N Patel
• Journal: Pediatric neurology (Pediatr Neurol) Vol. 54 Pg. 70-5 (Jan 2016) ISSN: 1873-5150 [Electronic] United States
• PMID: 26706481 (Publication Type: Journal Article)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Chemical References

• Neurotoxins
• Botulinum Toxins, Type A

Topics

• Adolescent
• Adult
• Botulinum Toxins, Type A (administration & dosage, adverse effects)
• Cerebral Palsy (complications, diagnostic imaging, drug therapy)
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Hospitals, Pediatric
• Humans
• Infant
• Injections (adverse effects, methods)
• Male
• Neurotoxins (administration & dosage, adverse effects)
• Retreatment (adverse effects)
• Retrospective Studies
• Salivary Glands (diagnostic imaging, drug effects)
• Sialorrhea (diagnostic imaging, drug therapy, etiology)
• Tertiary Care Centers
• Treatment Outcome
• Ultrasonography, Interventional (adverse effects, methods)
• Young Adult