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Toxins 2015, 7(7), 2481-2493; doi:10.3390/toxins7072481

Onabotulinumtoxin A Treatment of Drooling in Children with Cerebral Palsy: A Prospective, Longitudinal Open-Label Study

1
Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
2
Department of Neurology, Bispebjerg University Hospital, Copenhagen DK-2400, Denmark
3
Departments of Pediatrics and Radiology, Hvidovre University Hospital, Hvidovre DK-2650, Denmark
4
Gerbrandskolen, Copenhagen Municipal Dental Service, Copenhagen DK-2300, Denmark
*
Author to whom correspondence should be addressed.
Academic Editor: Bahman Jabbari
Received: 23 May 2015 / Revised: 14 June 2015 / Accepted: 19 June 2015 / Published: 30 June 2015
(This article belongs to the Collection Botulinum Toxins on Human Pain)
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Abstract

The aim of this prospective open-label study was to treat disabling drooling in children with cerebral palsy (CP) with onabotulinumtoxin A (A/Ona, Botox®) into submandibular and parotid glands and find the lowest effective dosage and least invasive method. A/Ona was injected in 14 children, Mean age 9 years, SD 3 years, under ultrasonic guidance in six successive Series, with at least six months between injections. Doses and gland involvement increased from Series A to F (units (U) per submandibular/parotid gland: A, 10/0; B, 15/0; C, 20/0; D, 20/20; E, 30/20; and F, 30/30). The effect was assessed 2, 4, 8, 12, and 20 weeks after A/Ona (drooling problems (VAS), impact (0–7), treatment effect (0–5), unstimulated whole saliva (UWS) flow and composition)) and analyzed by two-way ANOVA. The effect was unchanged–moderate in A to moderate–marked in F. Changes in all parameters were significant in E and F, but with swallowing problems ≤5 weeks in 3 of 28 treatments. F had largest VAS and UWS reduction (64% and 49%). We recommend: Start with dose D A/Ona (both submandibular and parotid glands and a total of 80 U) and increase to E and eventually F (total 120 U) without sufficient response. View Full-Text
Keywords: drooling; botulinum toxin; cerebral paresis; salivary flow; children drooling; botulinum toxin; cerebral paresis; salivary flow; children
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Møller, E.; Pedersen, S.A.; Vinicoff, P.G.; Bardow, A.; Lykkeaa, J.; Svendsen, P.; Bakke, M. Onabotulinumtoxin A Treatment of Drooling in Children with Cerebral Palsy: A Prospective, Longitudinal Open-Label Study. Toxins 2015, 7, 2481-2493.

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