title: Botulinum toxin in the treatment of sialorrhea.
abstract: OBJECTIVE
  Botulinum toxin-A (BTX-A) is known to block the release of acetylcholine from motor and autonomic nerve terminals and may significantly decrease saliva production when injected intraglandulary. The aim of this study was to evaluate effects of BTX-A injections in the treatment of disabling sialorrhea in various neurological disorders.
  
  
  METHODS
  This study included 19 consecutive patients with significant sialorrhea associated with various neurological disorders. Out of them 13 patients were with Parkinson's disease, two with pantothenate kinase-associated neurodegeneration, two with multiple system atrophy, one with Wilson's disease, and one patient with postoperative sialorrhea. Botulinum toxin-A (Dysport, Ipsen Pharma) was injected into the parotid glands with (n=7 patients) or without (n=12 patients) ultrasound guidance. All the patients were scored before and after the treatment and in weekly intervals thereafter using the salivation item of the part II (Activities of Daily Living) of the Unified Parkinson's Disease Rating Scale (UPDRS).
  
  
  RESULTS
  Thirteen patients (68%) reported beneficial effect of BTX-A injection, while 6 of them (32%) had no response at all The sialorrhea scores before and after the treatment were 3.1 +/- 0.1 (range 2-4) and 1.8 +/- 0.1 (range 0-3), respectively (t=5.636; p<0.001). There was no difference in the magnitude of response between the groups with (t=4.500; p=0.004) and without (t=3.674; p=0.005) ultrasound control of injection sites. Adverse effects were registered in 5 patients (26%).
  
  
  CONCLUSIONS
  Botulinum toxin-A injections to easily accessible parotid glands, without necessity for ultrasound guidance, are safe and efficaceous treatment for sialorrhea in different neurological disorders.
authors.affiliation: Clinical Centre of Serbia, Institute of Neurology, Belgrade, Serbia.
authors.forename: Marina
authors.initials: M
authors.lastname: Svetel
authors.forename: Milan
authors.initials: M
authors.lastname: Vasić
authors.forename: Natasa
authors.initials: N
authors.lastname: Dragasević
authors.forename: Tatjana
authors.initials: T
authors.lastname: Pekmezović
authors.forename: Igor
authors.initials: I
authors.lastname: Petrović
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kostić
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D010306:Parotid Gland; D012472:Salivation / Q000187:drug effects; D012798:Sialorrhea / Q000188:drug therapy* / Q000209:etiology
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A