23 Repeated onabotulinum neurotoxin A injections for drooling in children with neurodisability 1 INTRODUCTION Drooling, defined as the unintentional loss of saliva, is considered atypical when it persists after the age of 4 years.1 Children with cerebral palsy or other neurodisabilities often suffer from drooling.2 Drooling interferes with social interaction, and leads to intellectual underestimation and low self-esteem.3 When treating children with neurodevelopmental disabilities, drooling is easily overlooked. However, patients often consider it as one of their worst affections in relation to social interaction.3 Onabotulinum neurotoxin A (Botox; Allergan, Nieuwegein, the Netherlands) is currently the first-line interventional treatment for drooling because it is effective in the majority of patients, minimally invasive, and there is limited risk for severe adverse events.4 Yet, the effect is temporary, and to maintain effect injections are required at least once per year.4,5 Moreover, onabotulinum neurotoxin A injections generally take place under general anaesthesia and one injection necessitates multiple hospital visits including an anaesthesiologist visit and to monitor the effect on drooling.6,7 These drawbacks may lead to discontinuation of treatment. Another possible reason for discontinuation is the diminished or lack of effect after repeated injections.8 Neutralizing antibodies (NAb) or parotid gland compensation may play a role in the decrease of the effect after repeated injections, while alternative literature hypothesize gland atrophy and subsequently a permanent reduction in drooling.9–13 The aim of this study is to evaluate the effect of repeated onabotulinum neurotoxin A injections to reveal the usefulness of repeated injections for the treatment of drooling in neurodisabilities.
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