Botulinum Toxin in the Treatment of Drooling in Tetraplegic Patients With Brain Injury

Abstract

ObjectiveTo investigate the effect of botulinum toxin type A (BTA) injection into the salivary gland and to evaluate the changes of drooling in varied postures in tetraplegic patients with brain injury.MethodsEight tetraplegic patients with brain injury were enrolled. BTA was injected into each parotid and submandibular gland of both sides under ultrasonographic guidance. Drooling was measured by a questionnaire-based scoring system for drooling severity and frequency, and the sialorrhea was measured by a modified Schirmer test for the patients before the injection, 3 weeks and 3 months after the injection. Drooling was evaluated in each posture, such as supine, sitting, and tilt table standing, and during involuntary mastication, before and after the injection.ResultsThe severity and frequency of drooling and the modified Schirmer test improved significantly at 3 weeks and 3 months after the injection (p<0.05). Drooling was more severe and frequent in tilt table standing than in the sitting position and in sitting versus supine position (p<0.05). The severity of drooling was significantly increased in the patients with involuntary mastication (p<0.05).ConclusionSalivary gland injection of BTA in patients with tetraplegia resulting from brain injury who had drooling and sialorrhea could improve the symptoms for 3 months without complications. The severity and frequency of drooling were dependent on posture and involuntary mastication. Proper posture and involuntary mastication of the patients should be taken into account in planning drooling treatment.

Botulinum toxin treatment for hypersalivation in anti‐NMDA receptor encephalitis

“…Considering that the effect of BTX in the treatment of hypersalivation generally lasts about 2–4 months,19, 20 our finding suggests that duration of BTXA effect in hypersalivation due to anti‐NMDA receptor encephalitis is similar to that due to other neurological disorders. However, despite these results, its duration in anti‐NMDA receptor encephalitis still remains unclear because hypersalivation is significantly affected by disease activity.…”

Therapy of Sialorrhea with Botulinum Neurotoxin

“…The efficacy of BoNT treatment with serotype B (rimabotulinumtoxinB) has also been studied, as well as the effect of various BoNT-A preparations (abobotulinumtoxinA, incobo-tulinumtoxinA, onabotulinumtoxinA). The effects of all the toxins have been reproduced in case studies as well as in controlled studies, some of which were placebo controlled [1,[76][77][78][79][80][81].…”

Therapie der Sialorrhoe mit Botulinumtoxin

“…1). Die Wirkung für alle Toxine wurde in Fallserien und kontrollierten Untersuchungenteils placebokontrolliertreproduziert [75][76][77][78][79][80][81][82][83].…”

“…Der Wirksamkeitsnachweis erfolgte in fast allen Studien durch quantitative Messung der Speichelproduktion, wobei die Messung in der Regel durch Erfassung des Gewichts von in der Zahnmedizin üblichen Wattepads, die über einen definierten Zeitraum den neu gebildeten Speichel aufsaugen. Begleitend erfolgte in fast allen Untersuchungen eine Analyse der subjektiv vom Patienten (gelegentlich auch von Angehörigen) wahrgenommenen Wirkung auf Speichelfluss und Lebensqualität [81][82][83][84][85][87][88][89].…”