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European Journal of Pediatrics

, Volume 160, Issue 8, pp 509–512 | Cite as

Botulinum toxin A: a new option for treatment of drooling in children with cerebral palsy. Presentation of a case series

  • Peter H. Jongerius
  • Jan J. Rotteveel
  • Frank van den Hoogen
  • Frank Joosten
  • Karen van Hulst
  • Fons J. M. Gabreëls
ORIGINAL PAPER

Abstract

 Drooling beyond the age of 4 years is pathological, particularly if it occurs in children with neurological and developmental impairment and disability. Considering the therapeutic spectrum of botulinum toxin A and in view of the innervation of the salivary glands, we postulated that intraglandular injections into the submandibular glands with botulinum toxin A could reduce the secretion of saliva and consequently decrease drooling. Three patients with cerebral palsy and severe drooling were selected and evaluated over a 4-month period. Under ultrasound guidance, one dose of botulinum toxin A was injected bilaterally into the submandibular glands. Saliva secretion was measured at baseline and repeated four times during the following 4 months. In the three patients, maximal salivary flow rate of the sublingual and submandibular glands was reduced by 51% to 63%. The time of the maximal effect differed among the three children. The parents reported a satisfactory reduction of drooling throughout the whole study period. No objectionable disturbances of oral functions were observed. There was mild transient thickening of saliva in one of the patients.

Conclusion The application of botulinum toxin A to the submandibular gland is a promising technique to reduce salivary flow rate and probably an alternative in the treatment of drooling in children with cerebral palsy.

Key words Botulinum toxin Cerebral palsy Child Drooling Saliva Submandibular gland 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2001

Authors and Affiliations

  • Peter H. Jongerius
    • 1
  • Jan J. Rotteveel
    • 2
  • Frank van den Hoogen
    • 3
  • Frank Joosten
    • 4
  • Karen van Hulst
    • 2
  • Fons J. M. Gabreëls
    • 2
  1. 1.Department of Rehabilitation, University Hospital Nijmegen, PO Box 9101, 6500HB Nijmegen, The Netherlands Tel.: +31-24-3614804; Fax: +31-24-3619839 e-mail: P.Jongerius@policss1.azn.nlNL
  2. 2.Department of Paediatric Neurology, University Hospital Nijmegen, Nijmegen, The NetherlandsNL
  3. 3.Department of Otorhinolaryngology, University Hospital Nijmegen, Nijmegen, The NetherlandsNL
  4. 4.Department of Radiology, University Hospital Nijmegen, Nijmegen, The NetherlandsNL

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