Abstract
Background: We aimed to review and analyse the effectiveness and safety of botulinum toxin type A (BoNT-A) injections for drooling in children with cerebral palsy. Data sources: We searched the EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) databases from inception to January 2020. Methods: We included randomized controlled trials and observational studies which (1) involved children with cerebral palsy, (2) used BoNT-A for control of drooling, and (3) provided quantitative evaluations of drooling before and after intervention with BoNT-A. Results: Twenty-one trials met the inclusion criteria. Most studies showed that BoNT-A injections are safe and efficacious as a treatment for drooling in children with cerebral palsy. Four trials had sufficient data to pool the results for the meta-analysis. Both the drooling quotient (p = 0.002) and drooling Ffrequency and severity scale (p = 0.004) supported this conclusion. Conclusion: BoNT-A injections are a safe, reversible, effective treatment for drooling control in children with cerebral palsy that can offer effectiveness for more than 3 months with few side effects. The dosage of BoNT-A should not exceed 4 units/kg. Further studies are required to determine the optimal dosage and target glands.
Highlights
Drooling is the unintentional leakage of saliva from the mouth and is quite common in individuals with cerebral palsy (CP) [1]
Several approaches to managing drooling have existed for decades, including behavioural interventions, oral and topical medications, irradiation, and surgery [2,3,4,5,6,7]
We retrieved studies that met the following criteria (Figure 1): (1) randomised controlled trials (RCTs) or observational studies with more than five participants, (2) full-text articles published in English, (3) inclusion of participants aged 0–18 years with drooling secondary to a definite diagnosis of CP, (4) those on subject injected botulinum toxin type A (BoNT-A)
Summary
Drooling is the unintentional leakage of saliva from the mouth and is quite common in individuals with cerebral palsy (CP) [1]. Physiotherapy and behavioural modification techniques have been used to improve jaw stability, lip closure, and tongue mobility through strengthening of oral motor structures, prompting, and reinforcement [6,7] Most studies showed that BoNT-A injections are safe and efficacious as a treatment for drooling in children with cerebral palsy. Four trials had sufficient data to pool the results for the meta-analysis Both the drooling quotient (p = 0.002) and drooling Ffrequency and severity scale (p = 0.004) supported this conclusion. Conclusion: BoNT-A injections are a safe, reversible, effective treatment for drooling control in children with cerebral palsy that can offer effectiveness for more than 3 months with few side effects.
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