Affiliations: Department of Pediatrics, Universiti Kebangsaan
Malaysia Medical Centre, Kuala Lumpur, Malaysia | Department of Radiology, Universiti Kebangsaan
Malaysia Medical Centre, Kuala Lumpur, Malaysia
Note: [] Correspondence: Prof. Lai Choo Ong, Department of Pediatrics,
Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif Bandar Tun
Razak, 56000 Kuala Lumpur, Malaysia. Tel.: +603 91455383; Fax: +603 91737827;
E-mail: [email protected]
Abstract: The aim of this study was to determine whether botulinum toxin A
(BTX-A), injected into both parotid and submandibular salivary glands of
children with cerebral palsy and sialorrhea, could decrease their drooling and
improve their quality of life. Twenty-one children aged 4 to 12 years (mean age
8.4 years) received 60–80 units BTX-A (mean dose 3.6 U/kg) under sedation
using ultrasound guidance. Response was assessed by several methods (drool
frequency and severity score, drool quotient, number of bib changes per day and
a visual analogue score) at baseline, 2, 8 and 16 weeks post-injection. A
questionnaire related to quality of life and caregiver satisfaction was
administered at baseline and week 8. Adverse events were recorded at each
visit. Drool frequency and severity scores were significantly reduced at weeks
2, 8 and 16 compared to baseline (P < 0.001). Significant reductions were
also seen for the visual analogue scale, number of bibs changed daily and drool
quotient (P < 0.001). Mean quality of life scores dropped from 35 ±
4.8 at baseline to 29 ± 5.2) at week 8 (P < 0.001). Caregiver
satisfaction was high at weeks 2, 8 and 16. Pain or swelling (19%), excessively
thick saliva (9.5%), fever (9.5%) and chewing difficulties (4.8%) were
transient and subsided within 2 weeks of the injection. Eighteen (87.5%)
caregivers indicated they wanted repeat injections in the future. In
conclusion, percutaneous intraglandular injection of BTX-A was safe and had a
sustained effect for up to 16 weeks, with a concomitant improvement in their
quality of life and caregiver satisfaction.
Keywords: Cerebral palsy, sialorrhea, botulinum toxin A, children
