TREATMENT OF SIALORRHOEA WITH ULTRASOUND-GUIDED BOTULINUM TOXIN INJECTION IN PATIENTS WITH PARKINSON'S DISEASE OR AMIOTROPHIC LATERAL SCLEROSIS

Purpose: Sialorrhoea is frequent in neurodegenerative diseases. Anticholinergic drugs, radiation and surgery over salivary glands or ducts have been used to reduce drooling. These treatments are often ineffective or associated with severe side-effects. Recently, injection in the salivary glands of botulinum toxin (BTX) A or B emerged as a promising alternative treatment. We evaluated its efficacy and tolerability by ultrasound-guided injection in the salivary glands in patients with sialorrhoea associated to Parkinson's disease (PD) or Amiotrophic Lateral Sclerosis (ALS).

Methods and Materials: Sixteen patients (8 with PD and 8 with ALS) were included. Ultrasound-guided BTX-B injections were performed in parotids and submandibular glands by using a 7.5MHz linear probe (Esaote, Technos) and a 22-gauge Chiba needle. A total amount of 2500U of BTX-B per patient was administered (1000U in each parotid; 250U in each submandibular gland). In order to evaluate the treatment efficacy, the weight of cotton rolls weight before and after 5 minutes in the mouth, the visual analogic scale (VAS), and some dedicated clinical scales were performed before treatment, one week after, and on a monthly schedule until relapsing

Results: Maximal efficacy was reached in all patients within one week from treatment (mean latency 2.3 days). At 1-week evaluation, all patients reported significant reduction of sialorrhoea, as measured by cotton rolls weight (mean reduction 71,3%), and improvement in both clinical evaluation scales (86,5%) and VAS (213,6%). Reported side-effects were all mild and transient (pain during injections, subcutaneous hematomas (2), and feeling of viscous saliva (2)).

Conclusions: BTX-B injection in the salivary glands is efficacious in reducing sialorrhoea in patients with PD or ALS. Ultrasound guidance guarantees more accurate targeting of the glands' parenchyma and identification of inner and closer anatomical structures. Thus, side-effects as facial muscle weakness or lesions of the facial nerve or artery, are expected to be infrequent.