The children with cerebral palsy were subdivided by the predominant motor type [14]. All of the UK-371804 children demonstrated moderate to severe dysfunctional oral motor

control and had a score of 3 or higher on the Teacher Drooling Scale (a 5-point scale to express the clinical severity and frequency of drooling; 5 = constantly wet and leaking saliva, 1 = no drooling) [15]. None had undergone previous treatment with botulinum toxin type A or surgery for saliva control. For the statistical analyses, the following classifications were used: first, investigation of the influence of 3 categories (spastic cerebral palsy subtype, dyskinetic cerebral palsy subtype, and mental disability not classified within the cerebral palsy group), and second, exploration of the differences within the cerebral palsy group (the 2 cerebral palsy subtypes). All medications used to treat drooling or to influence salivary secretion (especially benzodiazepines and neuroleptic drugs) were discontinued at least 3 months before the start of the treatment. No limits were set concerning the use of antiepileptic drugs and the child’s level

of cognitive development. Data from children diagnosed with ataxic cerebral palsy subtype, Worster-Drought syndrome, or a progressive neurologic condition were excluded from the study. The research was conducted in Microtubule Associated inhibitor accordance with national and international ethics standards, and the Regional Committee on Research Involving Human Subjects approved the study. Informed consent was obtained from the parents or caregivers of all the study children. An ultrasound-guided injection of botulinum toxin type A was injected bilaterally into the submandibular salivary glands divided over 2 sites per gland with a 25-gauge needle (Spinocan). A total dose of 50 U of Botox (Allergan, Nieuwegein, The Netherlands), diluted with 1.5 mL saline, was used. below Drooling intensity and

salivary flow were measured at baseline and at 8 weeks after injection. Drooling intensity was evaluated by the Drooling Quotient, a semiquantitative observational method (expressed as a percentage) representing the actual clinical appearance of saliva loss. The Drooling Quotient was scored according to the original design: drooling was evaluated during a 10-minute episode. A drooling episode was defined as new saliva present on the lip margin or dropping from the chin. The presence or absence of drooling was assessed every 15 seconds (40 observations in 10 minutes) [16]. To measure the salivary flow rate, we used the swab method, as follows.