[Sialorrhea, hyperhidrosis and botulinum toxin].
OBJECTIVE
The first clinical studies indicate that Botox provides effective treatment for hyperhidrosis and sialorrhea. The aim of this work is to sum up current evaluation of this use.


METHODS
A systematic literature search was conducted on the Pub Med database, along with on chapters in other publications. The most interesting articles in relation to our own personal experience were chosen.


RESULTS
Despite recent use of BT to treat focal hyperhidrosis, there have been numerous publications since 1997. However, the injected areas have not been listed so frequently. Axillary hyperhidrosis has been studied most; it is also in this case and in the case of gustatory sweating that the best results have been obtained. Publications about palmar and especially plantar hyperhidrosis are much rarer, almost anecdotic. It has been demonstrated to a lesser extent that BT injections are effective in these cases. Literature about sialorrhea is just beginning. However, the reduction of the production of saliva following intra parenchymatic injection of toxin into the parotid and submandibular glands, thus rarifying drooling, has been demonstrated. For each of the pathological indications, both the injection techniques and the optimal doses remain to be determined.


CONCLUSIONS
Because BT blocks all cholinergic transmission, including the autonomous nervous system, it was plausible to expect a reduction in sweating and salivation on local injection of the product. In fact, the first publications indicated such efficiency without serious side effects. For hyperhidrosis, there has developed a consensus for making intracutaneous injections only. Of the injections in axillary areas, the palms of the hands, the plantar regions, the face or other cutaneous areas, palmoplantar hyperhidrosis is the least accessible, in any case causes the most technical problems, because of difficulty in pain management. For sialorrhea and the drooling that accompanies certain chronical neurological diseases, BT seems to have very promising effects. However, it has not been precisely determined whether to inject the parotid gland, the submandibular gland, or both. Necessary and sufficient means of targeting are still imprecise. It also remains to be determined the number of sites per gland and the doses to be injected.
Monnier
G
G
Explorations et pathologies neuromusculaires, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besançon cedex, France. guy.monnier@univ-fcomte.fr
Tatu
L
L
Parratte
B
B
Cosson
A
A
Michel
F
F
Metton
G
G
D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D006945:Hyperhidrosis / Q000188:drug therapy*; D010306:Parotid Gland / Q000502:physiology; D012798:Sialorrhea / Q000188:drug therapy*; D013363:Submandibular Gland / Q000502:physiology; D016896:Treatment Outcome
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins