[Drooling in neuropediatric patients]

[Therapy of Sialorrhea with Botulinum Toxin - An Update]

The most important salivary glands are the paired parotid and submandibular glands. Adults produce 1 to 1.5 liters of saliva which are then regularly swallowed. When the act of swallowing is disturbed, salivation occurs. More rarely, the cause can be found in increased saliva production, for example, when caused through medication. Sialorrhea impairs the quality of life substantially and is frequently often socially stigmatizing. Therapy includes conservative measures such as functional dysphagia therapy, oral or transdermal application of anticholinergics, as well as, in selected cases, radiation and surgical measures. Over the last 20 years, local injection of botulinum toxin has been successfully applied in the treatment of this condition. With approval of incobotulinumtoxinA toxin for children and adults, this procedure will become the therapy of choice for chronic sialorrhea. The results of the phase III registration trials have demonstrated high efficacy and good safety of the injection treatment in both children and adults.

Therapy of Sialorrhea with Botulinum Neurotoxin

Botulinum neurotoxin (BoNT) is considered the treatment of choice for various symptoms and diseases such as focal dystonia and focal spasticity. The effects of BoNT on the salivary glands have also been known for years, but their use was limited because of a lack of approval studies. Now the indication of sialorrhea is approved in some countries for incobotulinumtoxinA, such as the USA and Europe, and therapy could also become the treatment of choice. According to the pivotal study, a dose of 100 units of incobotulinumtoxinA, which is divided into the parotid and submandibular glands, is recommended. RimabotulinumtoxinB is approved in the USA only. To define the value of this therapy, we must consider anatomy, physiology, and available therapies. Therapy includes conservative measures such as functional dysphagia therapy, oral or transdermal application of anticholinergics, and, in selected cases, radiotherapy and surgical procedures. A combination of different approaches is optional. On the basis of the evidence and clinical experience, BoNT injections will be the first line of pharmacotherapy for chronic sialorrhea.

Das behinderte Kind

Die Zerebralparese hat eine Prävalenz von 1–2/1000 Lebendgeborene. Diese Zahlen sind in verschiedenen Kulturen relativ stabil und haben sich in den vergangenen 10–20 Jahren kaum verändert. Die Zerebralparese ist als eine prä-, peri- oder unmittelbar postpartal erworbene, nichtprogrediente Schädigung des Gehirns definiert. Es werden 3 Formen unterschieden: die spastische, die hypoton-ataktische und die dyston-athetoide Zerebralparese. Neben der Zerebralparese können auch andere klinische Krankheitsbilder mit einer muskulären Hypotonie oder einer Spastizität im Rahmen einer progredienten, z. B. metabolischen Erkrankung als Zeichen der neurologischen Störung zu schweren Behinderungen führen und mit klinisch relevanten gastrointestinalen Dysfunktionen und Symptomen assoziiert sein, die fast immer einer Langzeitbehandlung bedürfen. Etwa 60 % der Patienten zeigen eine Dysphagie, 40 % eine chronische pulmonale Mikroaspiration und mindestens 30 % einen klinisch signifikanten gastroösophagealen Reflux, eine Gastritis und abdominale Schmerzen. Mindestens 75 % der neurologisch behinderten Kinder leiden unter einer Obstipation, etwa ein Drittel zeigt die Merkmale einer Fehlund Unterernährung, wobei es große Unterschiede gibt, je nach Schweregrad der Behinderung.