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

Drooling beyond the age of 4 years is pathological, particularly if it occu rs in children with neurological and developmental impairment and disabilit y. 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 reduc e the secretion of saliva and consequently decrease drooling. Three patient s 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 wa s measured at baseline and repeated four times during the following 4 month s. 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 eff ect differed among the three children. The parents reported a satisfactory reduction of drooling throughout the whole study period. No objectionable d isturbances of oral functions were observed. There was mild transient thick ening 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 alter native in the treatment of drooling in children with cerebral palsy.