Department of Otorhinolaryngology and Head and Neck Surgery, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.
Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands.
Dev Med Child Neurol. 2021 Aug;63(8):991-997. doi: 10.1111/dmcn.14872. Epub 2021 Mar 27.
To evaluate the effect of repeated onabotulinum neurotoxin A injections for the treatment of drooling in children with neurodisabilities.
This was a retrospective cohort study, in which the first, second, and third onabotulinum neurotoxin A injection were compared within children treated between 2000 and 2020. Primary outcomes included drooling quotient, visual analogue scale (VAS), and treatment success defined as ≥50% reduction in drooling quotient and/or VAS 8 weeks after treatment. Each outcome was obtained at baseline and 8 weeks posttreatment.
Seventy-seven children were included (mean age at first injection: 8y 3mo, SD 3y 7mo, range 3-17y; 44 males, 33 females; 51.9% with cerebral palsy, 45.5% wheelchair-bound). The objective (drooling quotient) and subjective (VAS) effect after the second injection was lower compared to the first injection. The third injection showed less objective and significantly less subjective effect compared to the first injection. An overall success rate of 74.0%, 41.6%, and 45.8% were found for the first, second, and third injection respectively.
Although onabotulinum neurotoxin A remained effective throughout the entire treatment course, there is less effect of subsequent onabotulinum neurotoxin A injections compared to the first. Although there might be a loss of effect after repeated injections, there is continued improvement for most children. What this paper adds Repeated injections show a diminished treatment effect after the second injection. A continued improvement is seen in most patients.
评估重复使用肉毒毒素 A 治疗神经发育障碍儿童流涎的效果。
这是一项回顾性队列研究，比较了 2000 年至 2020 年间接受治疗的儿童的首次、第二次和第三次肉毒毒素 A 注射。主要结局包括流涎商数、视觉模拟量表（VAS）以及治疗成功定义为治疗后 8 周流涎商数和/或 VAS 减少≥50%。每个结果在基线和治疗后 8 周获得。
共纳入 77 名儿童（首次注射时的平均年龄：8 岁 3 个月，标准差 3 岁 7 个月，范围 3-17 岁；44 名男性，33 名女性；51.9%患有脑瘫，45.5%坐轮椅）。第二次注射后的客观（流涎商数）和主观（VAS）效果较首次注射降低。与首次注射相比，第三次注射的客观和主观效果明显降低。首次、第二次和第三次注射的总体成功率分别为 74.0%、41.6%和 45.8%。
尽管肉毒毒素 A 在整个治疗过程中仍然有效，但随后的肉毒毒素 A 注射效果较首次注射减弱。尽管重复注射后可能会出现效果丧失，但大多数儿童仍会持续改善。本文的意义在于，重复注射后第二次注射的治疗效果减弱。大多数患者仍会持续改善。
