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Repeated treatments of drooling with botulinum toxin B in neurology
Author(s) -
Møller E.,
Daugaard D.,
Holm O.,
Winge K.,
Bardow A.,
Lykkeaa J.,
Belhage B.,
Bakke M.
Publication year - 2015
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.12309
Subject(s) - drooling , saliva , medicine , sialorrhea , botulinum toxin , repeated measures design , analysis of variance , anesthesia , gastroenterology , surgery , statistics , mathematics
Objectives To investigate efficacy, saliva flow, and composition in repeated Bo NT ‐B treatments of drooling. Materials and methods Seventeen neurological patients (median 66 years), referred for treatment of drooling participated in this observational study. Median total doses of 4000 units botulinum toxin type B (Bo NT ‐B, Neurobloc ® ) were injected with at least 3 months intervals into parotid and submandibular glands using ultrasound guidance. Measures of drooling and saliva collection for analysis were obtained before treatment, and 6, 12, and eventually 18 weeks after. Results Number of treatment series in each patient was 1–7. Compared to baseline, saliva flow rate and drooling were reduced 30–70% 6 weeks after treatment in the first series, while sodium, chloride, and total protein increased 20–80% (t‐tests; P < 0.05). After 12 weeks, drooling was still significantly reduced, saliva flow tended to be, and saliva composition was back to baseline. Frequent side effects were viscous saliva and dry mouth. Due to fading effect in eight patients, individual decisions were taken to change from Bo NT ‐B to Bo NT ‐A. Similarly, the outcome was significantly reduced over time in six patients completing five subsequent Bo NT ‐B treatment series ( ANOVA ; P < 0.05). Conclusion In the first series, Bo NT ‐B treatment resulted in marked reduction of drooling and saliva flow rate with some relapse after 12 weeks. The viscous saliva was ascribed to increased total protein content and compensatory mechanisms related to ß‐adrenergic receptor‐specific actions. With patients needing long‐term treatment, it should be noted that the efficacy of repeated Bo NT ‐B may fade with time.