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; Theresia Kling; Kristina Huß; Ingo Borggraefe; Inga K. Koerte; Astrid Blaschek; Klaus Jahn; Florian Heinen; Steffen Berweck

doi:10.1055/s-0032-1307457

Neuropediatrics, Table of Contents

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

¹Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Campus Innenstadt, University of Munich, Germany

²Integrated Center for Research and Treatment of Vertigo,, Balance and Ocular Motor Disorders, IFB^LMU Campus Großhadern, University of Munich, Germany

,

Theresia Kling

¹Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Campus Innenstadt, University of Munich, Germany

,

Kristina Huß

¹Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Campus Innenstadt, University of Munich, Germany

,

Ingo Borggraefe

¹Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Campus Innenstadt, University of Munich, Germany

,

Inga K. Koerte

³Institute of Clinical Radiology, University of Munich, Germany

,

Astrid Blaschek

¹Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Campus Innenstadt, University of Munich, Germany

,

Klaus Jahn

²Integrated Center for Research and Treatment of Vertigo,, Balance and Ocular Motor Disorders, IFB^LMU Campus Großhadern, University of Munich, Germany

,

Florian Heinen

¹Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Campus Innenstadt, University of Munich, Germany

²Integrated Center for Research and Treatment of Vertigo,, Balance and Ocular Motor Disorders, IFB^LMU Campus Großhadern, University of Munich, Germany

,

Steffen Berweck

⁴Specialist Centre for Paediatric Neurology, Epilepsy Centre for Children and Adolescents, Vogtareuth, Germany

› Author Affiliations

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

Full Text

References

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