Abstract
Sialorrhea is a severe medical problem that is difficult to treat, which can lead to serious complications. In almost all cases, chronic sialorrhea is accompanied by a restriction of the child's contacts with peers, socialization difficulties, and a significant decrease in the quality of life. Nowadays, botulinum therapy can be an effective tool that significantly reduces sialorrhea manifestation.Oblective: to evaluate the effectiveness of Xeomin (incobotulinumtoxinA) in the treatment of sialorrhea in patients with spastic infantile cerebral palsy (ICP).Patients and methods. We enrolled 24 children with ICP (14 (58.3%) females, and 10 (41.7%) males) with various disease forms: 4 (16.6%) — with spastic hemiparesis, 6 (25.0%) — with spastic diplegia, and 14 (58.3%) — with spastic quadriparesis. IncobotulinumtoxinA injections were performed bilaterally in the parotid and submandibular salivary glands under ultrasound control at a total dose of 40-100 U (min 1.3, max 4.5 U/kg of body weight). IncobotulinumtoxinA. The Drooling Impact (DIS) and the Global Impression of Change Scale (GICS) were used 1, 3 and 6 months after IncobotulinumtoxinA injections to assess treatment effectiveness.Results and discussion. Botulinum toxin therapy resulted in a significant decrease in saliva discharge from the oral cavity 1 and 3 months after IncobotulinumtoxinA injections, which was demonstrated by a reduction in mean DIS score from 78.6±9.6 (min 62, max 95 points; 95% CI 74.6—82.7) to 48.7±6.7(min 25, max 61 points; 95% CI45.8—51.6) and 52.7±8.5points (min 22, max 65; 95% CI49.1—56.3), respectively, as well as an increase in delta GICSscore up to +1.3+0.8(min 0, max 3points; 95% CI 1.0—1.6) and +1.0+0.7points (min 0, max 3points; 95% CI 0.8—1.3), respectively. Adverse events were observed in 4patients (16.6%), which were classified as mild in 3 patients (did not require special treatment and completely stopped within six days) and moderate in 1 patient (also did not require special treatment and completely stopped within three weeks).Conclusion. In the majority (79.1%) of patients with ICP, it is possible to achieve high efficiency in reducing sialorrhea and this effect persists for at least 3 months.
Highlights
Botulinum toxin therapy resulted in a significant decrease in saliva discharge from the oral cavity 1 and 3 months after IncobotulinumtoxinA injections, which was demonstrated by a reduction in mean DIS score from 78.6±9.6 to 48.7±6.7 and 52.7±8.5 points, respectively, as well as an increase in delta Global Impression of Change Scale (GICS) score up to +1.3±0.8 and +1.0±0.7 points, respectively
Куренков А.Л. https://orcid.org/0000-0002-7269-9100 Кузенкова Л.М. https://orcid.org/0000-0002-9562-3774 Черников В.В. https://orcid.org/0000-0002-8750-9285 Бурсагова Б.И. https://orcid.org/0000-0001-8506-2064 Нежельская А.А. https://orcid.org/0000-0001-8032-6665 Артеменко А.Р. https://orcid.org/0000-0002-6219-3384
Summary
Применение IncobotulinumtoxinA для лечения сиалореи у пациентов с детским церебральным параличом. Для оценки эффективности лечения применяли Шкалу оценки влияния слюнотечения и Шкалу изменения общего впечатления через 1, 3 и 6 мес после инъекций IncobotulinumtoxinA. Ботулинотерапия приводила к значимому снижению выделения слюны из полости рта через 1 и 3 мес после проведения инъекций IncobotulinumtoxinA, что было оценено по снижению среднего балла по Шкале оценки влияния слюнотечения с 78,6±9,6 (min 62, max 95; 95% ДИ 74,6–82,7) до 48,7±6,7 (min 25, max 61; 95% ДИ 45,8–51,6) и 52,7±8,5 (min 22, max 65; 95% ДИ 49,1–56,3) соответственно и по положительной оценке по Шкале изменения общего впечатления до плюс 1,3±0,8 балла (min 0, max 3; 95% ДИ 1,0–1,6) и плюс 1,0±0,7 балла (min 0, max 3; 95% ДИ 0,8–1,3) соответственно. IncobotulinumtoxinA in the treatment of sialorrhea in patients with infantile cerebral palsy Kurenkov A.L.1, Kuzenkova L.M.1, Chernikov V.V.1, Bursagova B.I.1, Nezhelskaya А.А.1, Artemenko А.R.2. Oblective: to evaluate the effectiveness of Xeomin (incobotulinumtoxinA) in the treatment of sialorrhea in patients with spastic infantile cerebral palsy (ICP). The Drooling Impact (DIS) and the Global Impression of Change Scale (GICS) were used 1, 3 and 6 months after IncobotulinumtoxinA injections to assess treatment effectiveness
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