RESUMO
Drooling is a common and severe problem in children with neurological disorders and is caused by a disturbed coordination of orofacial and palatolingual muscles. Botulinum toxin could be a successful option to reduce excessive sialorrhea in children with neurological disorders. In 30 children with cerebral palsy or neurodegenerative disorder we injected under ultrasound guidance either botulinum toxin A or botulinum toxin B into the parotid and submandibular glands on both sides. All injections were well tolerated without general anaesthesia. Drooling severity at baseline and reduction of sialorrhea during treatment was measured using a parent's questionnaire and rated using the Teachers Drooling Scale (TDS). Reduction of sialorrhea was achieved two weeks after injection, with a positive effect lasting about three to four months in most children. 83% showed a good response to botulinum toxin after first injection, but only in 50% treatment was continued. We found no significant differences between botulinum toxin A or B. Side effects were observed in 5 children with viscous saliva and in one child a unilateral parotitis was observed. Treatment of drooling with botulinum toxin into the salivary glands is a safe and easy therapeutic option for children with neurological disorders to improve life quality.
Assuntos
Antidiscinéticos/uso terapêutico , Toxinas Botulínicas/uso terapêutico , Sialorreia/tratamento farmacológico , Adolescente , Toxinas Botulínicas/classificação , Toxinas Botulínicas Tipo A/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Doenças do Sistema Nervoso/complicações , Glândula Parótida/efeitos dos fármacos , Estudos Retrospectivos , Sialorreia/etiologia , Sialorreia/patologia , Glândula Submandibular/efeitos dos fármacos , Ultrassonografia/métodosRESUMO
This report demonstrates the effectiveness of long-term psychodynamic psychotherapy between a patient and therapist of different races. The patient's experience as a member of a minority was recognized, as were the psychodynamic meanings that race possessed in reference to identification, transference, resistance, and countertransference.