Botox shots for children go wrong

By CLAIRE TREVETT

It was supposed to be a simple procedure to ease the suffering of children with cerebral palsy.

But instead of bringing relief from involuntary drooling, the botox treatment at Starship hospital has left three children unable to swallow and having to feed through a tube.

The hospital has stopped using the botox procedure until a review is complete.

Six-year-old William Sangster was given botox injections in his salivary glands on Thursday, July 28.

Three days later, he was back in hospital after the botox paralysed the muscles used for swallowing.

Two other children aged around 10 and 17, also among six injected that day, were admitted with the same problem.

For the past two months, William has been fed liquids through a tube in his nose, and it could be next year before the botox wears off.

Starship hospital clinical leader Dr Richard Aicken said the reaction was totally unexpected.

The hospital had used the procedure for about a year with no adverse effects.

"I know it sounds like a relatively trivial problem, but these children with cerebral palsy are at school and they end up with the front of their clothing absolutely soaked [with saliva].

"It's really a miserable condition if it can't be controlled. So we are trying to make sure we have a rigorous process to find out why we had this problem."

Dr Aicken said an independent review by an academic ear, nose and throat surgeon was expected within two weeks.

An internal review found no mistakes in the procedure or the dose given.

"It's a dose within the range recommended and was not higher than has been used in other countries.

"The surgeon believes the dose he was using was within the range that other people would recommend.

"The reason he was using a higher dose than on previous occasions was because a range of the children had not had an adequate benefit from it the previous time it had been used.

"So he increased the dose a little to try to get a better result from it.

"But his review of the literature was that this was still within a totally acceptable range."

Dr Aicken did not know of any previous reports of the side-effect.

He said the duration of botox's effectiveness varied from person to person so he could not say how long it would be before William would be able to swallow.

But once the botox wore off, he should have no lingering problems.

The review would look at whether the treatment was unsuitable for some children, or whether it could be given in a different way which would prevent a recurrence of the problem.

Dr Aicken said Starship surgeons used ultrasound scanning to ensure the needle went into the salivary gland.

"We would think that would be safer than the way it is done in a lot of other places round the world, which just do it by sticking the needle in, sort of feeling around till they think they know where it is and then putting the botox in."

Botox blocks the nerve impulse that triggers secretion of saliva from the gland. An international study of 45 cerebral palsy sufferers found the treatment was effective in about half of cases. The only side-effect noted was mild difficulty swallowing.

William's mother, Lonili Lauaki, said she had had concerns about the dose he was given.

His father, Karl Sangster, said the operation had not been worth it.

"It's taken a huge chunk out of our life in terms of work, family life, and William's development."

William started at St Joseph's School in Onehunga this year after attending a pre-school for children with developmental problems.

What is botox?

Botulinum Toxin Type A

* A highly diluted form of botulinum toxin, derived from the bacteria that cause botulism food poisoning.

* Injected into the muscle, it causes mild paralysis by blocking the nerve impulse passing to the muscle.

* It is used for cosmetic reasons - to remove wrinkles and frown lines.

* It is also used for other conditions, including cerebral palsy, migraines, strokes, back or neck pain, eye tics, excessive sweating, and muscle spasms.