Safety of combined salivary gland and multilevel intramuscular onabotulinumtoxinA injections with and without ethanol in pediatric patients with cerebral palsy: A retrospective study
Issue title: Cerebral Palsy
Guest editors: Michael M. Green and Deborah Gaebler-Spira
Affiliations: [a] Pediatric Physical Medicine and Rehabilitation, Children’s Specialized Hospital, Clifton, NJ, USA | [b] Pediatric Physical Medicine and Rehabilitation, Columbia University Medical Center and Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA | [c] Physiatry, Blythedale Children’s Hospital, Valhalla, NY, USA | [d] Burke-Cornell Neurological Institute, White Plains, NY, USA | [e] Brain-Mind Research Institute, Weill Cornell Medicine, New York, NY, USA | [f] Blythedale Children’s Hospital, Valhalla, NY, USA
Correspondence:
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Corresponding author: Heakyung Kim, 180 Fort Washington Ave, Harkness Pavilion, St 1-165, New York, NY 10032, USA. Tel.: +1 212 305 5337; Fax: +1 212 342 1470; E-mail: hk2641@cumc.columbia.edu.
Abstract: OBJECTIVE: To evaluate the safety of combining salivary gland onabotulinumtoxinA (BTX-A) injections for sialorrhea with intramuscular BTX-A injections for spasticity in the same procedure. DESIGN: A retrospective cohort study in a tertiary hospital center. Patients selected were younger than 20 years, diagnosed with cerebral palsy, and received their first salivary gland BTX-A injection between March 2011 and July 2015. Chart review and telephone interviews were performed. The primary outcome measure was the rate of adverse events after combined BTX-A injections into salivary glands and muscles. The secondary outcome measure was the efficacy of injections, as reported by patients. RESULTS: Twenty-five of the 52 selected patients received salivary gland BTX-A injections only, and 27 received concurrent salivary gland and multi-level intramuscular chemodenervation with BTX-A with or without alcohol. The rate of adverse events was < 10% in both groups; 4% in “Salivary Only Group” and 7% in the “Salivary + Multilevel Intramuscular Chemodenervation with BTX-A group (with or without alcohol)”. Both approaches were equally effective in meeting their goals of salivary injections (> 50% improvement for at least two months). In the “salivary only” and in the “salivary + multi-level intramuscular” group, 76 and 85% of the patients reached their goals respectively. CONCLUSIONS: Combining BTX-A injections for sialorrhea with multilevel intramuscular BTX-A injections (with or without alcohol) appears to be safe and effective and allows treatment of patients for both conditions simultaneously.
