Effect of repeated onabotulinum toxin a injection into the salivary glands: an ultrasound measurement and a treatment for sialorrhea in familial dysautonomia
Bibliographic record
Abstract
Background: Sialorrhea or drooling has many clinical and functional complications such as choking, aspiration and skin breakdown in a population where the majority are patients with neurological disabilities (e.g. cerebral palsy, children with developmental delay). In addition there are psychosocial issues (e.g. isolation). There are several ways to treat drooling, ranging from medication to surgical intervention. A novel effective treatment using Onabotulinum Toxin A (Botox® - OBTXA) is currently available. Although this method is effective, it improves symptoms temporarily and its long term efficacy and safety are unknown. There are currently no radiologic studies examining the effect of repeated injections in human salivary glands nor studies demonstrating a safe, therapeutical treatment for drooling control in Familial Dysautonomia (FD). FD is a genetic disease affecting mainly the autonomic nervous system. Drooling control is difficult in this population as other management options are contraindicated due to their potential side effects. Objective: The overall objective of this thesis was 1) to assess the efficacy of repetitive use of OBTXA in salivary glands of children for the treatment of hypersalivation, and 2) to determine whether Botox is a good long term solution for drooling control. The thesis aimed to determine:1.Whether sialorrhea is associated with changes in either parotid or submandibular glands.2.To determine if gland size changes during OBTXA treatment3.To assess whether OBTXA is a safe treatment for sialorrhea in FD. Materials and methods: First, a prospective study compared the size of the salivary glands between drooling and non-drooling patients in one cohort (n = 36 salivary glands). Parotid and submandibular gland surface area, ML and AP dimensions were measured by ultrasound guidance in one session. Second, a prospective study compared the size of the salivary glands between drooling patients treated with repetitive OBTXA injections and a control group. Third, a retrospective case report study of three children with FD who underwent OBTXA injection to treat sialorrhea.Results: The parotid and submandibular salivary glands in the paediatric population do not differ in size in drooling and non-drooling children. However, the salivary glands decrease in size after repetitive OBTXA treatment. Intraglandular OBTXA treatments in FD patients reduced the frequency and severity of sialorrhea.Conclusions: There is no difference in the size of the salivary glands in drooling and non-drooling children. We found that the salivary glands decrease in size during treatment with OBTXA. Measuring the glands at baseline and after Onabotulinum toxin A (OBTXA) injections allows evaluation of treatment-related size changes in the gland. Moreover, OBTXA was found to be a safe and effective therapeutic treatment for sialorrhea control in Familial Dysautonomia.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".