title: Acute deterioration of bulbar function after botulinum toxin treatment for sialorrhoea in amyotrophic lateral sclerosis.
abstract: Transcutaneous botulinum toxin injection in the salivary glands was introduced in 2000 as a new treatment for sialorrhoea in amyotrophic lateral sclerosis (ALS). We describe an ALS patient who developed serious complications of botulinum toxin treatment for sialorrhoea, and we review the relevant literature. A 64-yr-old woman with bulbar ALS for 6 mos was treated for disabling sialorrhoea. She had moderate dysphagia, but she was able to swallow. The submandibular and parotid glands were injected transcutaneously, under ultrasound guidance, with botulinum toxin (Dysport), 80 U on each side. Four days later, her bulbar function rapidly deteriorated, resulting in complete aphagia and anarthria on the fifth day. A PEG catheter was placed. Although according to the literature this treatment can be made safer by cautiously increasing the dosage and injecting the parotid glands first, BTX should not be the first-line treatment of sialorrhoea in ALS; comparative studies of BTX, amitryptiline, scopolamine, and radiation should be performed first.
authors.affiliation: Rehab Centre Tolbrug/Jeroen Bosch Hospital, s-Hertogenbosch, The Netherlands.
authors.forename: Jan-Willem G
authors.initials: JW
authors.lastname: Meijer
authors.forename: Annet A
authors.initials: AA
authors.lastname: van Kuijk
authors.forename: Alexander C H
authors.initials: AC
authors.lastname: Geurts
authors.forename: H Jurgen
authors.initials: HJ
authors.lastname: Schelhaas
authors.forename: Machiel J
authors.initials: MJ
authors.lastname: Zwarts
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000150:complications*; D001049:Apnea / Q000139:chemically induced*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000009:adverse effects*; D003680:Deglutition Disorders / Q000139:chemically induced / Q000188:drug therapy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007267:Injections; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000009:adverse effects*; D010306:Parotid Gland / Q000187:drug effects; D012798:Sialorrhea / Q000188:drug therapy* / Q000209:etiology; D013363:Submandibular Gland / Q000187:drug effects
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A