| BackgroundDrooling refers to a group of syndromes in which salivary glands are secreted or saliva overflows from the corner of the mouth or swallowing discomfort is caused by multiple factors.Drooling is a common complication in children with cerebral palsy,and its incidence is reported inconsistently in literature.It is reported from 10%to 78%in foreign countries but 25%to 35%in domestic reports.Conventional treatment methods for drooling include oral exercise training,behavioral therapy,anticholinergic drugs and surgical et al,but there are problems such as limited efficacy or difficult to tolerate side effects.In 1997,Botulinum neurotoxin type A(BoNT-A)was first injected into the parotid and submandibular glands to treat drooling and achieved good results;In recent years,many studies on BoNT injection for drooling have been carried out abroad.At present,Botulinum neurotoxin(BoNT)injection is considered to be the most evidence-based treatment method with fewer adverse reactions worldwide.At present,there are not many domestic reports on the drooling of children with cerebral palsy treated with BoNT,and there is no systematic information on the effectiveness,safety and side effects of BoNT-A after treatment.In this study,60U and 80U of BoNT-A were injected into the parotid and submandibular glands of two groups of children under ultrasound guidance.The purpose was to observe the efficacy and safety of 60U and 80U of BoNT-A on drooling in children with cerebral palsy.PurposeThe purpose is to observe the clinical effects and adverse reactions of different doses of botulinum toxin type A in the treatment of drooling in children with cerebral palsy under ultrasound guidance.MethodsFifty-six children with cerebral palsy and drooling were included and divided into two groups A and B according to the random number table.There were 28 children in group A and 28 children in group B.During the follow-up,5 cases fell off due to various reasons,and a total of 51 cases were included,including 24 cases in group A and 27 cases in group B.BoNT-A injection was completed under the guidance of a color Doppler ultrasound system.BoNT-A was injected into the parotid and submandibular glands of the child under ultrasound guidance.Each site was injected with 10U of type A botulinum toxin,and 40U of BoNT-A was injected into parotid gland of each child.10u BoNT-A was injected into each submandibular gland in group A,The total dose is 20U.20U BoNT-A was injected into each submandibular gland in group B.The total dose is 40U.The total doses in the two groups were:the total injection dose in group A was 60U,and the total dose in group B was 80U.Before and 2,8,12 and 24 weeks after BoNT-A injection,the level of drooling each patient of the t group was evaluated by Visual Analogue Scale(VAS),teacher drooling sizing(TDS),the drooling quotient(the drooling quotient)and Saxon test(Saxon test),and the side-effects were observed.ResultsThe research indicated that there was no significant difference in TDS score,VAS score,the drooling quotient and Saxon test between the two groups(P>0.05).In each group,there were statistically significant differences at after the 2 weeks,8 weeks,12 weeks and 24 weeks with before injection in TDS score,VAS score,the drooling quotient and Saxon test in both groups(P<0.05).There were no serious side-effects related to BoNT-A injection.Conclusions1.It is effective and without serious adverse reactions to decrease the salivation in children with cerebral palsy with the injection of Ultrasound-guided BoNT-A into the parotids and submandibulars glands;2.The best treatment for the salivation in children with cerebral palsy is within 2 weeks with the injection of BoNT-A.After 8 weeks,therapeutic effect decreases gradually.There are statistically significant differences for two experimental groups compared with data before the injection of BoNT-A after 24 weeks.3.There is no significant difference in the efficacy of total 60U and 80U.60U is recommended as the total injection dose. |
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