Botulinum toxin type A treatment for Parkinsonian patients with moderate to severe sialorrhea

Purpose: To investigate the effect of botulinum toxin type A (BTX-A; Botox®) in reducing saliva in patients with Parkinsonism. Methods: Fifteen patients with clinical diagnosis of idiopathic Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy were enrolled in this open clinical trial. A total of 40-unit dose of Botox® was injected into the bilateral parotid and submandibular glands. Objective measuring of saliva production with dental rods, subjective Drooling Score, personal impression of clinical improvement, and the duration of response were used for the global assessment of sialorrhea after BTX-A treatment. Results: All patients showed objective reduction in saliva production following BTX-A treatment and the mean production was reduced at a significant level. The severity of sialorrhea assessed by Drooling Score was 5.87±0.92 (range: 5-8) and 3.60±1.18 (range: 2-6) respectively (p<0.001) before and after BTX-A injection. The mean duration of BTX-A response extended for 16.3±5.7 weeks (range: 5-24). No severe adverse effect nor worsening of existing dysphagia was observed in all Parkinsonian patients. Conclusions: Parkinsonian drooling may undermine patient's health and daily activity. BTX-A local injection is a safe and effective measure in counteracting sialorrhea, even in patients associated with moderate dysphagia.