The impact of botulinum toxin type A in the treatment of drooling in children with cerebral palsy secondary to Congenital Zika Syndrome: an observational study.
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.
['Sales|Henrique F|HF|', 'Cerqueira|Caroline|C|', 'Vaz|Daniel|D|', 'Medeiros-Rios|Débora|D|', 'Armani-Franceschi|Giulia|G|', 'Lucena|Pedro H|PH|', 'Sternberg|Carla|C|', 'Nóbrega|Ana C|AC|', 'Luz|Cleber|C|', 'Fonseca|Danilo|D|', 'Carvalho|Alessandra L|AL|', 'Monteiro|Larissa|L|', 'Siqueira|Isadora C|IC|', 'Bandeira|Igor D|ID|', 'Lucena|Rita|R|']
D019274:Botulinum Toxins, Type A D002547:Cerebral Palsy D002675:Child, Preschool D005260:Female D006801:Humans D008137:Longitudinal Studies D008297:Male D009465:Neuromuscular Agents D011446:Prospective Studies D012798:Sialorrhea D000071243:Zika Virus Infection
botulinum toxin type A drooling Cerebral palsy Congenital Zika Syndrome Doppler ultrasonography