Botulinum toxin type A in the treatment of sialorrhea - Our experience

Abstract

Sialorrhea consists of an involuntary loss of saliva, and is considered pathological after 4YO. The aim of this study is to describe our methodology and evaluate the efficacy and safety of Botulinum Toxin Type A (BTX-A) in sialorrhea in children and adults with cerebral palsy (CP) or cognitive deficit, referenced to PMR consultation between 2002–2017. Longitudinal descriptive study with clinical records analysis and consultation of drooling rate scale (DRS) and teacher drool scale (TDS) prior to BTX-A injections and 1-month after. Injection of BTX-A performed with ultrasound and sedation. Total of 104 patients, 86 patients selected, 32 female (37.21%), 54 male (62.79%), current ages 7–29YO (mean 18), age of the 1st application 3–22YO (mean 9.76), age of last application 4–23YO (mean 11.83). Fifty patients (58.14%) diagnosed with CP. Two hundred and three total applications (average 2.36), maximum 10 applications. Parotids (55.56%), submandibular (9.09%) or both (35.35%), mean periodicity of 11.81 months. Sedation: 49.38% midazolam, 41.36% nitrogen protoxide, 0.62% Chloral-Hydrate and 8.64% without. Surveys: mean pre-application-DRS of 33.98 (minimum 19, maximum 58), mean post-application-DRS of 28.46 (min 15, max 54), with P = 6.48–5, average difference 4.28 points in DRS (min −27, max 22). Mean pre-application-TDS of 4.04 (min 2, max 5), mean post-applicantion-TDS of 3.38 (min 1, max 4), with P = 2.80–5, average difference of 0.69 points in TDS (min −1, max 3). Difference in DRS and TDS of 0.76 and 0.24 respectively in the parotids, 6.33 and 0.83 in the submandibular and 8.52 and 1.43 in both. Improvements were statistically significant. Surgery: 6 (6.98%). Side effects: 5 children (5.81%) insomnia/vomiting. No complications related to the administration technique. The application of BTX-A in the treatment of sialorrhea is a safe, easy-to-apply technique, with statistically significant improvement in QoL and severity. Benefit in the application of BTX-A in both glands treatment is shown.