Efficacy and Duration of Botulinum Toxin Treatment for Drooling in 131 Children

OBJECTIVE: To address the efficacy of botulinum toxin and the duration of its effect when used on a large scale for the treatment of drooling in children with neurological disorders. DESIGN: Prospective cohort study. SETTING: Academic multidisciplinary drooling clinic. PATIENTS: A total of 131 children diagnosed as having cerebral palsy or another nonprogressive neurological disorder and who also have moderate to severe drooling. INTERVENTION: Injection of botulinum toxin to the submandibular glands. MAIN OUTCOME MEASURES: Direct observational drooling quotient (DQ) (0-100) and caretaker visual analog scale (VAS) scores (0-100). RESULTS: A clinically notable response was found in 46.6% of children, reflected in a significant mean reduction in DQ from a baseline of 29 to 15 after 2 months and 19 after 8 months (P < .001). The mean VAS score decreased from 80 at baseline to 53 after 2 months and increased to 66 after 8 months (P < .001). Kaplan-Meier analysis showed that patients who initially responded to treatment experienced relapse after a median of 22 weeks (interquartile range, 20-33 weeks). CONCLUSIONS: Our study provides further support for botulinum toxin's efficacy for treatment of drooling in approximately half of patients for a median of 22 weeks. Further optimization of patient selection should be an area of attention in future studies.