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Toxins 2018, 10(2), 55; https://doi.org/10.3390/toxins10020055

Botulinum Toxin A for Sialorrhoea Associated with Neurological Disorders: Evaluation of the Relationship between Effect of Treatment and the Number of Glands Treated

1
Neurology Department, Garibaldi Hospital, 95100 Catania, Italy
2
Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool L271XF, UK
3
Department of Biomedical and Biotechnological Sciences, Section of Physiology, University of Catania, 95100 Catania, Italy
4
UOC di Medicina Fisica e Riabilitazione, Comiso-Vittoria, ASP Ragusa, 97013 Ragusa, Italy
5
ENT Department, University of Padova, 35121 Padova, Italy
6
DANA Department, “GF Ingrassia”, Neuroscience Section—Multiple Sclerosis Center, University of Catania, 95100 Catania, Italy
7
School of Physical Medicine and Rehabilitation, University of Padua, 35121 Padua, Italy
8
Department of Surgery, University of Catania, 95100 Catania, Italy
9
IRCCS Centro Neurolesi “Bonibo-Pulejo”, via Provinciale Palermo, Contrada Casazza, 95124 Messina, Italy
*
Author to whom correspondence should be addressed.
Received: 21 December 2017 / Revised: 22 January 2018 / Accepted: 22 January 2018 / Published: 27 January 2018
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Abstract

Background: Sialorrhoea and drooling are disabling manifestations of different neurological disorders. The aim of this study was to evaluate the effects of botulinum neurotoxin type A (BoNT/A) injection on hypersalivation in 90 patients with neurological diseases of different aetiologies, and to define the minimum number of injected salivary glands to reduce sialorrhoea. Determining the minimum number of glands that need to be engaged in order to have a significant reduction in drooling may be very useful for establishing the minimum total dosage of BoNT/A that may be considered effective in the treatment of hypersalivation. Methods: Twenty-five mouse units (MU) of BoNT/A (onabotulinumtoxin A, Botox; Allergan, Irvine, CA, USA; 100 MU/2 mL, 0.9% saline; or incobotulinumtoxin A, Xeomin; Merz Pharma, Germany; 100 MU/2 mL, 0.9% saline) were percutaneously injected into the parotid (p) glands and/or submandibular (s) glands under ultrasound control. On this basis, patients were divided into three groups. In group A (30 patients), BoNT/A injections were performed into four glands; in group B (30 patients), into three glands, and in group C (30 patients), into two glands. Patients treated in three glands (group B) were divided into two subgroups based on the treated glands (2 p + 1 s = 15 patients; 2 s + 1 p = 15 patients). Similarly, patients being injected in two glands (group C) were subdivided into three groups (2 p = 10 patients; 1 p + 1 s = 10 patients; 2 s = 10 patients). In patients who were injected in three and two salivary glands, saline solution was injected into the remaining one and two glands, respectively. Assessments were performed at baseline and at 2 weeks after the injections. Results: BoNT/A significantly reduced sialorrhoea in 82 out of 90 patients. The effect was more evident in patients who had four glands injected than when three or two glands were injected. The injections into three glands were more effective than injections into two glands. Conclusions: Our results have shown that BoNT/A injections induced a significant reduction in sialorrhoea in most patients (91%). In addition, we demonstrated that sialorrhoea associated with different neurological diseases was better controlled when the number of treated glands was higher. View Full-Text
Keywords: sialorrhoea; drooling; salivary glands; swallowing; botulinum toxin; eccrine glands; onabotulinumtoxin A; incobotulinumtoxin A sialorrhoea; drooling; salivary glands; swallowing; botulinum toxin; eccrine glands; onabotulinumtoxin A; incobotulinumtoxin A
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Restivo, D.A.; Panebianco, M.; Casabona, A.; Lanza, S.; Marchese-Ragona, R.; Patti, F.; Masiero, S.; Biondi, A.; Quartarone, A. Botulinum Toxin A for Sialorrhoea Associated with Neurological Disorders: Evaluation of the Relationship between Effect of Treatment and the Number of Glands Treated. Toxins 2018, 10, 55.

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