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Neuropediatrics 2012; 43(01): 027-036
DOI: 10.1055/s-0032-1307457
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Botulinum Toxin Type A and B for the Reduction of Hypersalivation in Children with Neurological Disorders: A Focus on Effectiveness and Therapy Adherence

A. Sebastian Schroeder
1   Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Campus Innenstadt, University of Munich, Germany
2   Integrated Center for Research and Treatment of Vertigo,, Balance and Ocular Motor Disorders, IFBLMU Campus Großhadern, University of Munich, Germany
,
Theresia Kling
1   Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Campus Innenstadt, University of Munich, Germany
,
Kristina Huß
1   Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Campus Innenstadt, University of Munich, Germany
,
Ingo Borggraefe
1   Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Campus Innenstadt, University of Munich, Germany
,
Inga K. Koerte
3   Institute of Clinical Radiology, University of Munich, Germany
,
Astrid Blaschek
1   Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Campus Innenstadt, University of Munich, Germany
,
Klaus Jahn
2   Integrated Center for Research and Treatment of Vertigo,, Balance and Ocular Motor Disorders, IFBLMU Campus Großhadern, University of Munich, Germany
,
Florian Heinen
1   Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Campus Innenstadt, University of Munich, Germany
2   Integrated Center for Research and Treatment of Vertigo,, Balance and Ocular Motor Disorders, IFBLMU Campus Großhadern, University of Munich, Germany
,
Steffen Berweck
4   Specialist Centre for Paediatric Neurology, Epilepsy Centre for Children and Adolescents, Vogtareuth, Germany
› Author Affiliations
Further Information

Publication History

24 October 2011

01 February 2012

Publication Date:
19 March 2012 (online)

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Abstract

Botulinum toxin (BoNT) is an established treatment option to reduce hypersalivation in children with chronic neurological disorders. Objective of this study was (1) to discriminate differences in efficacy and safety of repeated interventions using BoNT with a focus on different preparations used and (2) to look for effectiveness and treatment adherence from a qualitative research perspective in this single-center cohort study. We prospectively assessed goal attainment scaling, drooling severity and frequency score and the number of towels/day before, and 4 to 8 weeks after intervention. A parent questionnaire assessed therapy-related effects on quality of life retrospectively. A total of 19 out of 34 patients received repeated injections of BoNT (106 total). Mean dose: 95 units onabotulinumtoxinA (Botox®), 2383 units rimabotulinumtoxinB (Neuro-/Myobloc®). Outcome parameters showed a distinct reduction in all treatment groups with a higher efficacy of riB. The child's need for care was reduced in 79% and social interaction improved in 84%. Main reason for discontinuation was “not enough effect” and “formation of antibodies.” riB showed to be more effective in reducing hypersalivation, but antibody-formation seems to be clinically relevant. Despite clinical efficacy treatment adherence is influenced by personal and environmental factors of parents and caretakers balancing the short-term clinical benefit versus the burden of intervention.

Keywords

hypersalivation - sialorrhea - children - botulinum toxin type A - botulinum toxin type B - treatment adherence
 

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