Effectiveness of the Botulinum Toxin for Treating Sialorrhea in Patients with Parkinson’s Disease: A Systematic Review

Abstract

The main objective was to assess the efficacy of botulinum toxin-based treatment for sialorrhea in adult patients with Parkinson’s disease. The search was performed by using the Medline-PubMed, EMBASE and Cochrane Library databases from January 2000–December 2017, in English/Spanish in patients with Parkinson’s disease and sialorrhea. The methodological quality of trials was carried out by following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria and the Newcastle–Ottawa Scale (NOS). Finally, a total of 21 articles were identified as fulfilling the inclusion criteria. There is no consensus regarding the site of injection of the toxin (single or multiple points), toxin dose or follow-up period. In all cases there was a reduction of sialorrhea. Treatment safety increases with the use of ultrasonography. Effects approximately occur at one week post-injection and for 3–5 months. Botulinum toxin is an effective therapeutic strategy or option in treating sialorrhea in adult patients with Parkinson’s disease. More studies with a better design, larger samples and a longer follow-up period are required to confirm these data.

Therapy of Sialorrhea with Botulinum Neurotoxin

“…In August 2019 rimabotulinumtoxinB was approved in the USA (1500-3000 units). More studies with larger samples and longer follow-up periods are desirable to confirm the recent data [106].…”

Non-Surgical Strategies for Assisting Closure of Pharyngocutaneous Fistula after Total Laryngectomy: A Systematic Review of the Literature

“…Botulinum toxin therapy represents one of the many pharmacological strategies to reduce salivary flow, which is a major culprit in PCF formation and persistence [6 bomeli]. This molecule has been extensively used in the treatment of sialorrhea for many neurological syndromes [ 42 , 43 , 44 , 45 ]. Botulinum toxin starts to reduce the salivary secretion from 72 h after the periparotid infiltration and it has a more noticeable effect after 5 to 7 days [ 46 ]; its action is reversible and it lasts about 2–4 months, and with minimal systemic side effects [ 47 ].…”

Neurotrophic effects of Botulinum neurotoxin type A in hippocampal neurons involve activation of Rac1 by the non-catalytic heavy chain (HCC/A)

“…In conclusion, we have demonstrated that BoNT/A elicits neurotrophic effects via HC C /A-mediated activation of Rac1. Properly administered, BoNT/A has already been shown to be a safe drug and, indeed, it induces sprouting in nerves of patients suffering from Parkinson’s disease and amyotrophic lateral sclerosis ( Kulshreshtha et al, 2020 , Moller et al, 2011 , Ruiz-Roca et al, 2019 , Vazquez-Costa et al, 2016 ). Clearly, caution must be used when comparing the sprouting response at the neuromuscular junction in vivo with neurite outgrowth from cultured neurons.…”