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Toxins 2015, 7(7), 2481-2493;

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

Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen DK-2200, Denmark
Department of Neurology, Bispebjerg University Hospital, Copenhagen DK-2400, Denmark
Departments of Pediatrics and Radiology, Hvidovre University Hospital, Hvidovre DK-2650, Denmark
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)
Full-Text   |   PDF [810 KB, uploaded 30 June 2015]   |  


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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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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