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Sialorrhea: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins
Department of Neurology, Yale School of Medicine, 15 York Street LLCI-920 New Haven, CT 06520, USA
Department of Neurology, Case Western Reserve University, Cleveland, OH 44106, USA
* Author to whom correspondence should be addressed.
Received: 1 March 2013; in revised form: 9 April 2013 / Accepted: 24 April 2013 / Published: 21 May 2013
Abstract: Sialorrhea or excessive drooling is a major issue in children with cerebral palsy and adults with neurodegenerative disorders. In this review, we describe the clinical features, anatomy and physiology of sialorrhea, as well as a review of the world literature on medical treatment using Yale University’s search engine; including but not limited to Medline and Erasmus. Level of drug efficacy is defined according to the guidelines of American Academy of Neurology. Current medical management is unsatisfactory. Topical agents (scopolamine and tropicamide) and oral agents (glyccopyrolate) combined render a level B evidence (probably effective); however, this treatment is associated with troublesome side effects. Double-blind and placebo-controlled studies of botulinum toxin (BoNT) provide a level A evidence for type B (two class I studies; effective and established) and both overall and individual B level of evidence for OnabotulinumtoxinA (A/Ona) and AbobotulinumtoxinA (A/Abo); these are probably effective. For IncobotulinumtoxinA (A/Inco), the level of evidence is U (insufficient) due to lack of blinded studies. Side effects are uncommon; transient and comparable between the two types of toxin. A clinical note at the end of this review comments on fine clinical points. Administration of BoNTs into salivary glands is currently the most effective way of treating sialorrhea.
Keywords: botulinum neurotoxins; botox; drooling; pytialis; double-blind; therapy; topical agents; oral agents
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Lakraj, A.A.; Moghimi, N.; Jabbari, B. Sialorrhea: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins. Toxins 2013, 5, 1010-1031.
Lakraj AA, Moghimi N, Jabbari B. Sialorrhea: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins. Toxins. 2013; 5(5):1010-1031.
Lakraj, Amanda A.; Moghimi, Narges; Jabbari, Bahman. 2013. "Sialorrhea: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins." Toxins 5, no. 5: 1010-1031.