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Drooling affects a high proportion of children with cerebral palsy: in a survey of 160 children (most of them with spastic quadriplegia), in UK special schools, more than half had drooling and it was severe in one third of the children. Drooling may cause choking, skin excoriation and infection, dehydration, care difficulties, and psychological and social problems for children and parents. Treatments include physical techniques to improve posture, oromotor manipulation, intraoral appliances, oral or topical anticholinergics and, in severe cases, surgery. In adults with neurological or malignant diseases, injection of botulinum toxin A (BTX‐A) into salivary glands has relieved drooling for up to 5 months. (BTX‐A inhibits acetylcholine release from presynaptic nerve terminals.) Several studies in children have shown positive results and now a study in Sydney, Australia, has added further evidence (Katie J Banerjee and colleagues. Developmental Medicine and Child Neurology 2006;48:883–7).
Twenty children with cerebral palsy and significant drooling (mean age 10 years (range 6–16 years), 10 girls) were treated with BTX‐A (2 U/kg up to a maximum of 70 U). The drug was divided, 1.4 U/kg into the parotid glands and 0.6 U/kg into the submandibular glands, and injected under midazolam and nitrous oxide sedation with ultrasound guidance. There was significant reduction in drooling severity scores at 4 and 12 weeks and in quantitative assessment of drooling (number of scarves/bibs per day) at 4 weeks. The quality‐of‐life scores rated separately by parents and teachers were improved significantly at 12 weeks. No adverse events were attributed to the injections, and almost all (89%) parents and children opted to have more injections. Intraglandular BTX‐A might occupy a place in between anticholinergic drugs and surgery for the treatment of severe drooling.