Botulinum toxin for treatment of parkinsonian sialorrhea.
OBJECTIVE
Sialorrhea is one of the main problems of patients with Parkinson's disease (PD). Most of the medications used for the treatment of it are ineffective. We decided to try in such patients local injections of botulinum toxin, type A, into both parotid glands.


METHODS
11 patients with clinical diagnosis of idiopathic PD and drooling assessed as at least 2 point on the UPDRS part II and 14 control subjects.


METHODS
Salivation was measured by weighting dental rolls before and 2 minutes after insertion at 6 places of highest secretion of saliva in mouth (buccal vestibule, and sublingual area). PD patients were assessed before and one week after injections of 5 units of BOTOX into each parotid salivary gland and the results were compared to the salivation of controls.


RESULTS
Average excretion of saliva in PD patients was significantly higher than in controls -0.39 +/- 0.4 g/2 min. (range: 0.02-1.82) vs. 0.19 +/- 0.16 g/2 min. (range: 0.02-0.98) (p = 0.03). After the treatment the average excretion of saliva in PD patients decreased to 0.25 +/- 0.26 g/2 min. (range: 0.004-0.99) and did not differ significantly from controls. All patients improved also according to UPDRS. No side-effects were observed in any of the patients injected.


CONCLUSIONS
Botulinum toxin may be an effective and safe treatment of parkinsonian sialorrhea.
Friedman
A
A
Department of Neurology, Medical University of Warsaw, Warsaw, Poland. Friedman@amwaw.edu.pl
Potulska
A
A
D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010300:Parkinson Disease / Q000150:complications*; D010306:Parotid Gland / Q000187:drug effects / Q000378:metabolism; D012472:Salivation / Q000187:drug effects; D012798:Sialorrhea / Q000188:drug therapy* / Q000209:etiology*; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A