Salivary gland botulinum toxin injections for drooling in children with cerebral palsy and neurodevelopmental disability: a systematic review

I have been using this modality of treatment for many years. My clinical observation is that it is effective with few severe side effects.  I have been counting the decrease in the number of bibs  or  shirt changes  as well because it is hard to quantify the response. JR

Salivary gland botulinum toxin injections for drooling in children with cerebral palsy and neurodevelopmental disability: a systematic review

Aim  The aim of this paper was to systematically review the efficacy and safety of botulinum toxin (BoNT) injections to the salivary glands to treat drooling in children with cerebral palsy and neurodevelopmental disability.

Method  A systematic search of The Cochrane Central Register of Controlled Trials, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, and the Physiotherapy Evidence Database (PEDro) was conducted (up to 1 October 2011). Data sources included published randomized controlled trials (RCTs) and prospective studies.

Results  Sixteen studies met inclusion criteria. Three outcome measures support the effectiveness of BoNT for drooling. One RCT found an almost 30% reduction in the impact of drooling on patients’ lives, as measured by the Drooling Impact Scale (mean difference −27.45; 95% confidence interval [CI] −35.28 to −19.62). There were sufficient data to pool results on one outcome measure, the Drooling Frequency and Severity Scale, which supports this result (mean difference −2.71; 95% CI −4.82 to −0.60; p<0 .001=".001" 2="2" 41="41" a="a" adverse="adverse" because="because" bibs="bibs" but="but" day.="day." early="early" events.="events." events="events" from="from" in="in" incidence="incidence" inconsistently="inconsistently" number="number" observed="observed" of="of" one="one" p="p" per="per" ranged="ranged" reduction="reduction" reported.="reported." required="required" significant="significant" terminated="terminated" the="the" there="there" to="to" trial="trial" was="was">

Interpretation  BoNT is an effective, temporary treatment for sialorrhoea in children with cerebral palsy. Benefits need to be weighed against the potential for serious adverse events. More studies are needed to address the safety of BoNT and to compare BoNT with other treatment options for drooling.

 link here

Boy with Cerebral Palsy Walks to his Marine Dad Returning from Deployment

A boy with cerebral palsy was told he'd never walk, but did just that when he saw his returning Marine dad.

http://video.insider.foxnews.com/thumbnails/694940094001/2012/05/10/640/360/694940094001_1631328903001_vs-1631314523001.jpg

link here

'Laughing gas' sedation calms pediatric hospital patients

'Laughing gas' sedation calms pediatric hospital patients

I am at my cerebral palsy/ "Botox" clinic today in san Antonio. Its amazing to see how cal kids are with sedation. Laughing gas makes this quick and easy.

SAN ANTONIO -- Doctors at a San Antonio hospital are using a new tool to make their smallest patients more comfortable. It’s a sedation method dentists have used for years.
This is a less invasive way to sedate children for procedures. All it requires is a mask and about three minutes.

Keeping the smallest of patients calm and tranquil during procedures is no small task. Many diagnostic or therapeutic interventions require IV sedation where children are unconscious. For some patients, though, there’s another less invasive alternative.

Gas. It’s nitrous oxide, the same stuff you’d call “laughing gas” at the dentist.

At North Central Baptist Hospital in Stone Oak, the pediatric sedation unit has been using this approach of the last two months with great success.

“They’re awake the whole time,” explained Dr. Daniel Sedillo, a pediatric critical care specialist. “You can talk to them and tell them to take a deep breath or to relax and once you take the gas off within two or three minutes they’re back to their playful self as they were before.”

The gas can be kept up for about half an hour and allows doctors to do everything from injections to biopsies, from spinal tapes to MRI scans.

The children have less angst and fear and the doctors have a cooperative patient to work on.

“The physicians who were doing the procedure were very happy that they were able to do the procedure comfortably without the child moving a whole lot and not having to see tears or screaming or anything like that,” Sedillo remarked.

Using nitrous oxide as a sedative means parents don’t have to worry as much about what their children eat before the procedure. The recovery to full consciousness is faster.

http://www.kens5.com/home/Laughing-gas-sedation-calms-pediatric-hospital-patients-103462504.html

Treatment-induced plasticity in cerebral palsy - MRI shows changes with treatment

Last week, I was honored with the invitation to address the Pediatrics Department at the University of Texas. I offered a review on cerebral palsy diagnosis and treatment. Here is an interesting article suggesting brain plasticity after standard treatments.

Sadly many children are not referred for multimodal treatment

Dr. Rotenberg

Pediatr Neurol. 2008 Nov;39(5):341-9.

Treatment-induced plasticity in cerebral palsy: a diffusion tensor imaging study.

Trivedi R, Gupta RK, Shah V, Tripathi M, Rathore RK, Kumar M, Pandey CM, Narayana PA.

Source

Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Abstract

Diffusion tensor imaging is used as a measure of white-matter organization to probe mechanisms underlying clinical responses. Diffusion tensor imaging and clinical assessment in 8 patients with spastic quadriparesis (mean age, 6.13 years) was performed before and 6 months after therapy (botulinum injection, followed by physiotherapy). All patients were graded on the basis of gross motor function. Serial diffusion tensor imaging was also performed on 10 age/sex-matched controls at baseline and after 6 months. Regions of interests were placed on corticospinal tracts at different levels (i.e., corona radiata, posterior limb of internal capsule, midbrain, pons, and upper medulla) and on other major white-matter tracts, in both patients and controls. A significant increase in fractional anisotropy was evident in corticospinal tracts at the level of the posterior limb of the internal capsule and periventricular white matter of the temporal lobe, relative to baseline values in the patient group. Gross motor function classification system grades improved in all patients during follow-up relative to baseline values. The increase in fractional anisotropy in corticospinal tracts, along with improved clinical motor scores, suggests plasticity of the central motor pathway after combined therapy.