ABSTRACT

Objective

The main aim of this study was to determine the impact of botulinum toxin A (BTX-A) on severity and frequency of drooling in children with Cerebral Palsy (CP) secondary to Congenital Zika Syndrome (CZS).

Methods

This is a prospective longitudinal observational study including 23 children who received bilateral injections of BTX in the parotid and submandibular glands. The Thomas-Stonell & Greenberg Drooling Severity and Frequency Scale was applied by a multidisciplinary team including Speech, Language and Hearing professionals. The Global Impression of Improvement (GII) Scale was also applied to assess parents’ subjective perceptions of therapeutic response. Swallowing was assessed using Doppler ultrasonography. Univariate logistic regression was used to analyse differences between responders and non-responders.

Results

Participant age varied from 27 to 38 months (mean 31.78, SD = 2.61) all presented with Gross Motor Function Classification System (GMFCS) V. Drooling Severity and Frequency Scale scores ranged from 7 to 9 points (median = 9) prior to BTX administration and from 4 to 6 (median = 6) after. Pre- and post-treatment reduction in drooling severity occurred (Z = −3.746; p < 0.001). No cases of drooling worsening were reported. Only two subjects presented adverse effects attributed to BTX administration. Correlation was only confirmed with GII.

Discussion

This article presents the safe and positive impact of BTX-A administration guided by anatomical references described in the literature, even on children with microcephaly. Further studies are needed to facilitate the use of Doppler ultrasonography as a tool to characterize changes in sensory processing and motor response following intraoral input in children with CP.

中文翻译：

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A型肉毒杆菌毒素对先天性寨卡综合征继发脑瘫患儿流口水治疗的影响：一项观察性研究。

摘要

客观的

本研究的主要目的是确定肉毒杆菌毒素 A (BTX-A) 对继发于先天性寨卡综合征 (CZS) 的脑瘫 (CP) 儿童流口水的严重程度和频率的影响。

方法

这是一项前瞻性纵向观察研究，包括 23 名在腮腺和下颌下腺接受双侧 BTX 注射的儿童。Thomas-Stonell & Greenberg 流口水严重程度和频率量表由包括语音、语言和听力专业人士在内的多学科团队应用。全球改善印象 (GII) 量表也用于评估父母对治疗反应的主观看法。使用多普勒超声检查吞咽情况。单变量逻辑回归用于分析响应者和非响应者之间的差异。

结果

参与者年龄从 27 个月到 38 个月不等（平均 31.78，SD = 2.61），全部采用粗大运动功能分类系统 (GMFCS) V。在 BTX 给药前，流口水严重程度和频率量表评分范围为 7 到 9 分（中位数 = 9）从 4 到 6（中位数 = 6）之后。治疗前后流口水严重程度降低（Z = -3.746；p < 0.001）。没有报告流口水恶化的病例。只有两名受试者出现了归因于 BTX 给药的不良反应。仅与 GII 确认了相关性。

讨论

本文介绍了以文献中描述的解剖学参考为指导的 BTX-A 给药的安全和积极影响，甚至对小头畸形儿童也是如此。需要进一步研究以促进使用多普勒超声作为表征 CP 儿童口腔内输入后感觉处理和运动反应变化的工具。