Effects of Repeated Botulinum Toxin Treatment for Sialorrhea in Patients with Parkinson’s Disease

Şen, Aysu; Arpacı, Baki

doi:10.5152/npa.2015.7477

Cited by 9 publications

(12 citation statements)

References 22 publications

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“…Accordingly, striking structural abnormalities of neuromuscular junctions and intramuscular nerves were more pronounced after repetitive injections. Moreover, in human therapeutic BoNT-A application, more distinct and longer lasting effects, resulting in an increase in the mean duration of efficacy with the number of injections are well known [ 41 , 42 , 43 , 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Repeated Intrastriatal Botulinum Neurotoxin-A Injection in Hemiparkinsonian Rats Increased the Beneficial Effect on Rotational Behavior

Hawlitschka

Holzmann

Wree

et al. 2018

Toxins

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Injection of botulinum neurotoxin-A (BoNT-A) into the striatum of hemiparkinsonian (hemi-PD) rats reduced apomorphine-induced rotation behavior significantly, for at least 3 months. Thereafter, rotation behavior increased again. We injected hemi-PD rats with 1 ng BoNT-A twice, the second injection following 6 months after the first one and tested the rats for apomorphine-induced rotations and spontaneous motor behaviors, i.e., corridor task and stepping test. To test the hypothesis that BoNT-A reduced striatal hypercholinism in hemi-PD rats, the acetylcholinesterase inhibitor donepezil was injected prior to separate apomorphine-induced rotation tests. In hemi-PD rats, the first BoNT-A injection led to a clear reduction of the apomorphine-induced rotations, and the second BoNT-A injection to a more massive and prolonged reaction. In hemi-PD rats whose apomorphine-induced rotation behavior was strongly reduced by an intrastriatal BoNT-A, subsequent donepezil injections led to significant increases of the rotation rate. Concerning corridor task and stepping test, neither first nor second BoNT-A injections changed hemi-PD rats’ behavior significantly. The data give evidence for the possibility of repeated intrastriatal administrations of BoNT-A, for treatment of motor symptoms in experimental hemi-PD over a longer time.

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Section: Discussionmentioning

confidence: 99%

Repeated Intrastriatal Botulinum Neurotoxin-A Injection in Hemiparkinsonian Rats Increased the Beneficial Effect on Rotational Behavior

Hawlitschka

Holzmann

Wree

et al. 2018

Toxins

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“…Among all the salivary glands, the parotid gland is the major target when injecting botulinum toxin in all studies, and can be treated alone [6,7,16] or, what happens in most studies [3,10,14,15,17,18], along with the submandibular glands, since both produce 90% of total saliva. There are two studies [4,19] that do not specify into which gland the treatment is applied.…”

Section: Discussionmentioning

confidence: 99%

“…In relation to the adverse effects, it should be noted that in three studies no side effects were highlighted, in two of them nothing was specified in that regard, and in the rest of cases in which an alteration occurred, this was of a mild nature, for example viscous saliva, dry mouth, difficulty in the motor control of tongue, skin reaction and aggravation of previous dysphagia. [4,7,13,14,15,16,26,27,28,29].…”

Section: Discussionmentioning

confidence: 99%

“…The effect is temporary and lasts until the presynaptic terminals regenerate, usually up to three months [15]. Accordingly, repeated injections are required [16]. Despite the importance of the application of botulinum toxin to treat sialorrhea in Parkinson’s disease, there is lack of clear consensus concerning the safest and most effective treatment method and specific clinical guidelines or recommendations.…”

Section: Introductionmentioning

confidence: 99%

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

Ruiz-Roca

Pons-Fuster

López‐Jornet

2019

JCM

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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.

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“…86 Retrospective analysis of patients in a movement disorders clinic showed that all patients treated with BoNT-A experienced improvements; a minimum of 50% improvement in sialorrhoea was observed using the Drooling Severity and Frequency Scale (DSFS). 87 The majority of PD outpatients completing an RCT reported satisfaction with BoNT treatment [moderate to dramatic improvement (77.7%; n = 18)] compared with placebo [no changes to mild improvement (94.4%; n = 18)]. 83 All patients receiving BoNT injections stated that they would receive repeated injections.…”

Section: Current Treatment Options For Sialorrhoeamentioning

confidence: 99%

The burden of sialorrhoea in chronic neurological conditions: current treatment options and the role of incobotulinumtoxinA (Xeomin®)

Morgante

Bavikatte

Anwar

et al. 2019

Ther Adv Neurol Disord

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Sialorrhoea is a frequent symptom of neurological diseases (e.g. Parkinson’s disease, motor neuron disease, cerebral palsy, and stroke) and is defined as excessive saliva accumulation leading to unintentional loss of saliva from the mouth. Sialorrhoea increases the overall burden on the patient and their caregivers, the impact of which can be both physical and psychosocial. Treatments for sialorrhoea range from lifestyle and behavioural guidance, to medications, surgery or radiation. Nonpharmacological interventions include advice on posture, swallowing control, cough management, dietary changes, eating and drinking techniques, and behavioural modification; however, these conservative measures may be ineffective for people with progressive neurological conditions. The pharmacological treatment of sialorrhoea is challenging because medications licensed for this purpose are limited, but treatments can include anticholinergic drugs and botulinum toxins. Surgical treatment of sialorrhoea is typically reserved as a last resort for patients. IncobotulinumtoxinA (Xeomin®) is the first botulinum toxin type A to receive US and UK marketing authorization for the symptomatic treatment of chronic sialorrhoea due to neurological disorders in adults. In this review, we discuss and compare the frequency and method of administration, location of treatment delivery, approximate annual costs and main side effects of botulinum toxin and different anticholinergic drugs. Management of patients with chronic neurological conditions requires input from multiple specialist teams and thus a multidisciplinary team (MDT) approach is considered fundamental to ensure that care is consistent and tailored to patients’ needs. To ensure that adult patients with neurological conditions receive the best care and sialorrhoea is well managed, we suggest a potential clinical care pathway for sialorrhoea with a MDT approach, which healthcare professionals could aspire to.

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Effects of Repeated Botulinum Toxin Treatment for Sialorrhea in Patients with Parkinson’s Disease

Cited by 9 publications

References 22 publications

Repeated Intrastriatal Botulinum Neurotoxin-A Injection in Hemiparkinsonian Rats Increased the Beneficial Effect on Rotational Behavior

Repeated Intrastriatal Botulinum Neurotoxin-A Injection in Hemiparkinsonian Rats Increased the Beneficial Effect on Rotational Behavior

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

The burden of sialorrhoea in chronic neurological conditions: current treatment options and the role of incobotulinumtoxinA (Xeomin®)

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