[Treatment of sialorrhoea in neurological diseases with trans-dermic injections of botulinum toxin type A in the parotid glands]

Abstract

Introduction: Sialorrhoea is a disabling problem in many patients affected by neurological disorders. Anticholinergic drugs often produce side effects in these patients. Botulinum toxin A (TBA) blocks liberation of acetil-choline in motor and autonomic nerve terminals.

Methods: We report preliminary data about three patients, affected by motor neuron disease, Parkinson's disease and pons infarction respectively. All of them underwent treatment with TBA in both parotid glands to treat sialorrhoea, and were prospectively evaluated. Severity and Frequency Sialorrhoea Scale was used pre-treatment and at 6 weeks. TBA was administered in two points in each gland; a new injection was done at 2 weeks, with a dose ranging between 10 and 20 units in each point.

Results: Three males, with a men age of 63.6 years are reported. Sialorrhoea pre-treatment severity score was 5 while pre-treatment frequency score was 4 (continuous sialorrhoea all the days). Six weeks after TBA injection, two patients scored 2 in severity and frequency (mild sialorrhoea) and third patient had a score of 3 (moderate sialorrhoea). Side effects were observed neither after TBA injections nor at 6 week follow-up.

Conclusions: Trans-dermic injection of TBA is safe and effective technique to treat sialorrhoea in neurological diseases when used by neurologists with experience, with few side effects.