Botulinum toxin improves sialorrhea and quality of living in bulbar amyotrophic lateral sclerosis

Abstract

Sialorrhea is frequently a socially disabling symptom in patients with bulbar amyotrophic lateral sclerosis (ALS). In this open-label prospective study, we report the effect of botulinum toxin A (Botox) injection into the parotid glands in 10 patients with bulbar ALS and socially disabling sialorrhea. We applied three different outcome measures to determine the effect of Botox therapy on sialorrhea. Botox significantly improved the degree of sialorrhea and a drooling impact score and, by inference, the quality of living, in over half of the patients with bulbar ALS and severe sialorrhea. The beneficial effect of Botox lasted for at least 2 months in those who responded. No major adverse effects were noted. Local injection of a small dose of Botox into the parotid glands can control sialorrhea and potentially improve living quality in some patients with bulbar ALS.

Speech Impairment, Phonation, Writing, Salivation, and Swallowing in Patients with Parkinson’s Disease

“…Sialorrhea deined as an overlow of saliva from the mouth (drooling) and negatively afects both patient's quality of life and social interactions [20,21]. Its etiology includes acute and chronic neurological disorders (such as PD), hypersecretion (inlammatory processes in oral cavity), adverse efects of some drugs, or anatomic abnormalities afecting oral cavity [22].…”

Cross-Sectional Survey of Relevant Literatures as to the Current Proposed Disease Mechanisms and Treatments of Amyotrophic Lateral Sclerosis (ALS)

“…In ALS patients suffering from upper esophageal sphincter hyperactivity and sialorrhea small clinical trials have demonstrated measurable increases in quality of life outcomes through botulinum administration. [132][133][134] Specifically, patients with UES hyperactivity experienced decreases in dysphagia for up to four weeks 132 while sialorrhea was reduced for up to two months.…”

A Review of Options for Treating Sialorrhea in Amyotrophic Lateral Sclerosis

“…38 Orally administered anticholinergic drugs are often interrupted due to systemic side effects, such as sedation and delirium, which are especially common in elderly patients. 39 Anticholinergic drugs can also cause thickening of mucous secretions in the throat and lungs, which is a far worse and more severe complication than drooling. 14 Pupillary dilatation, skin reactions, and urinary retention are also minor adverse effects of scopolamine skin patches.…”

“…In Table 3, we present the most relevant studies concerning the use of BoNT in the treatment of sialorrhea in ALS. 39 A typical regimen is the administration of a total dose of 250 U of BoNT-A: 100 U diluted in 0.4 mL of saline injected into 2 sites of each parotid gland and 25 U diluted in 0.1 mL of saline injected into a single site of each submandibular gland. Another common approach is the injection of total dose of 2,500 U of BoNT-B, again subdivided into 2 sites of injection for each parotid gland (1,000 U in 0.4 mL of saline) and a single site of injection for each submandibular gland (250 U in 0.1 mL of saline).…”

“…Sialorrhea is reduced 3-7 d after the injections, and maximum reduction occurs ϳ2-4 weeks after treatment. The mean duration of the beneficial effect is usually three and half months, 39 although the relapse time is extremely variable, and inhibition of saliva production may last up to 6 months after injection. 44 BoNT serotypes A and B are considered to be equally efficacious and safe.…”