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The use of botulinum toxin in the treatment of sialorrhea in parkinsonian disorders

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Abstract

Drooling is a common symptom in parkinsonian disorders. Our aim was to assess the safety and effect of botulinum toxin when applied to parotid glands without ultrasound guidance for sialorrhea in parkinsonian disorders in a retrospective study with a long-term follow-up. We evaluated 53 patients (64.2 % male and 35.8 % female) with a mean age of 70.18 ± 9.25 years who were treated in our centre between 2007 and 2013. We analysed the mean dose, latency, effect duration, response and adverse effects of treating sialorrhea by injecting botulinum toxin type A (Botox) into the parotid glands without ultrasound guidance. A total of 41 patients with Parkinson’s disease, 6 with progressive supranuclear palsy, 4 with multiple system atrophy and 2 with corticobasal degeneration were included. The mean duration of the disease at onset was 10.51 ± 6.81 years and the mean sialorrhea duration was 1.99 ± 1.55 years. The initial dose used for each parotid gland was 14.53 ± 3.95 units of Botox, with a mean dose of 22.17 ± 8.76 units. There was an improvement after treatment in 65.22 % of patients with an average score of 6.85 ± 1.58 points on a scale from 0 to 10. The duration of the treatment effect was 4.38 ± 2.11 months, with a latency period of 10.06 ± 9.63 days. Adverse effects were mild and infrequent. Botulinum toxin is a safe and effective therapy for the treatment of sialorrhea in parkinsonian disorders and there is no requirement for ultrasound guidance. It has a rapid onset and lasting effect without requiring a high dosage.

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Acknowledgments

This work was supported by grants from the Ministerio de Economía y Competitividad de España (SAF2007-60700), the Instituto de Salud Carlos III (PI10/01674, CP08/00174), the Consejería de Economía, Innovación, Ciencia y Empresa de la Junta de Andalucía (CVI-02526, CTS-7685), the Consejería de Salud y Bienestar Social de la Junta de Andalucía (PI-0377/2007, PI-0741/2010, PI-0437-2012), the Sociedad Andaluza de Neurología, the Fundación Alicia Koplowitz, the Fundación Mutua Madrileña and the Jaques and Gloria Gossweiler Foundation.

Conflict of interest

Dr. Pablo Mir received fees for consultancy and support for conference attendances from Allergan and he received funds for unrestricted grants and conference attendances from Merz. The other authors declare that they have no conflicts of interest related to the contents of this article.

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Authors and Affiliations

  1. Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, 41013, Seville, Spain

    María T. Gómez-Caravaca, María T. Cáceres-Redondo, Ismael Huertas-Fernández, Laura Vargas-González, Fátima Carrillo, Manuel Carballo & Pablo Mir

  2. Centro de Investigación en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Seville, Spain

    Pablo Mir

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  1. María T. Gómez-Caravaca
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  2. María T. Cáceres-Redondo
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  6. Manuel Carballo
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  7. Pablo Mir
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Correspondence to Pablo Mir.

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Gómez-Caravaca, M.T., Cáceres-Redondo, M.T., Huertas-Fernández, I. et al. The use of botulinum toxin in the treatment of sialorrhea in parkinsonian disorders. Neurol Sci 36, 275–279 (2015). https://doi.org/10.1007/s10072-014-1950-y

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