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Botox for newborns

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Published: 17 Mar 2008

Using a common cosmetic drug to treat hypersalivation at the Montreal Children's Hospital of the MUHC.

Using a common cosmetic drug to treat hypersalivation at the Montreal Children's Hospital of the MUHC.

Botulinum toxin, also called Botox, is best known as one of the most commonly used molecules to reduce wrinkles. It is also known as one of the most poisonous naturally occurring substances.

Now, thanks to Dr. Sam Daniel, Associate Director of Research of the Otorhinolaryngology Division at the Montreal Children's Hospital of the McGill University Health Centre, this protein has become an effective method to save newborns suffering from CHARGE Syndrome from having to undergo devastating tracheotomies. Dr. Daniel describes the case of the first infant patient treated with the toxin in an article from the Archives of Otolaryngology dated March 17th.

CHARGE Syndrome is rare, but it can become life-threatening in its most severe form. The syndrome includes a variety of birth defects in different organs, such as the heart, eyes or ears, but it also affects the salivary glands. They are hyper-stimulated and secrete excessive fluids that are discarded into the lungs, causing asphyxia. This was the case for the patient that Dr. Daniel discusses in his article: at the age of two and a half months, little Franck (not his real name) was still unable to breathe without assistance and a tracheotomy seemed inevitable in order to relieve his respiratory system.

Seeing the despair of Franck's parents, Dr. Daniel proposed an experimental treatment as a last recourse: the injection of a minute dose of Botox into each of Franck's salivary glands. This had never been done before on such a young child, but no other option could prevent permanent intubation. Two weeks after the injections, Franck's extubation was a success. He now leads the normal life of a three-year-old boy at home with his parents.

Botulinum toxin is a very powerful neurotoxin, meaning that it blocks nerve activity. In Franck's case, it blocked the nerves that stimulated his salivary glands thereby reducing their secretions to a normal level. The infant then needed repeated injections every four to six months for one and a half years until his glands shrunk and stopped overproducing saliva.

Since this first attempt 5 years ago, Dr. Daniel has performed over 1000 Botox injections in young children including 12 in newborns. "This treatment is extremely effective, and to date I have not encountered any major side effects despite the bad press Botox got recently. It also helps us considerably improve the lives of our patients," he explained.

Dr Daniel has started sharing his expertise by training specialists in many hospitals around the world and in Canada. The interdisciplinary Saliva Management Clinic he founded at the MAB-MacKay Rehabilitation Centre, the first of its kind in Quebec, helps children and teens who are socially stigmatized and isolated because of their excessive drooling. It has recently celebrated its 3-year anniversary and has received an Award of Excellence for Innovation to acknowledge its development of novel methodologies and therapeutic/rehabilitative approaches for motor deficiencies. L'Association des établissements de réadaptation en déficience physique du Québec (AERDPQ) presented the Centre with the award during its recent annual banquet.

Dr Sam Daniel is Associate Director of Research of the Otorhinolaryngology Division at the Montreal Children's Hospital of the McGill University Health Centre, and Associate professor at McGill University.

The parents of the child mentioned in this press release have given us permission to tell their son's story, but do not wish to make the child's name public and they have declined the opportunity to do media interviews.

The McGill University Health Centre (MUHC) is a comprehensive academic health institution with an international reputation for excellence in clinical programs, research and teaching. The MUHC is a merger of five teaching hospitals affiliated with the Faculty of Medicine at McGill University--the Montreal Children's, Montreal General, Royal Victoria, and Montreal Neurological Hospitals, as well as the Montreal Chest Institute. Building on the tradition of medical leadership of the founding hospitals, the goal of the MUHC is to provide patient care based on the most advanced knowledge in the health care field, and to contribute to the development of new knowledge. www.muhc.ca

The Research Institute of the McGill University Health Centre (RI MUHC) is a world-renowned biomedical and health-care hospital research centre. Located in Montreal, Quebec, the institute is the research arm of the MUHC, a university health center affiliated with the Faculty of Medicine at McGill University. The institute supports over 500 researchers, nearly 1000 graduate and post-doctoral students and operates more than 300 laboratories devoted to a broad spectrum of fundamental and clinical research. The Research Institute operates at the forefront of knowledge, innovation and technology and is inextricably linked to the clinical programs of the MUHC, ensuring that patients benefit directly from the latest research-based knowledge. For further details visit: www.muhc.ca/research.

The Montreal Children's Hospital is the pediatric teaching hospital of the McGill University Health Centre (MUHC). The institution is a leader in the care and treatment of sick infants, children, and adolescents from across Quebec. The Montreal Children's Hospital provides a high level and broad scope of health care services, and provides ultra specialized care in many fields including: cardiology and cardiac surgery; neurology and neurosurgery, traumatology; genetic research; psychiatry and child development and musculoskeletal conditions, including orthopedics and rheumatology. Fully bilingual and multicultural, the institution respectfully serves an increasingly diverse community in more than 50 languages. www.thechildren.com

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