title: Long-term follow-up of ultrasound-guided botulinum toxin-A injections for sialorrhea in neurological dysphagia.
abstract: Literature provides reports only of a limited follow-up single injection of botulinum toxin-A (BoNT-A) in patients with sialorrhea. The aim of our study is to evaluate the long-lasting efficacy and safety of ultrasound-guided BoNT-A injections for severe sialorrhea secondary to neurological dysphagia. We enrolled 38 severe adult sialorrhea patients referred consecutively to the neurology unit and performed bilateral parotid and submandibular gland BoNT-A injections under ultrasound guidance. The outcomes of the study were reduction of sialorrhea, duration of therapeutic effect, and subjective patient- and caregiver-reported satisfaction. A total of 113 BoNT-A administrations were given during the study period with a mean duration of follow-up of 20.2 ± 4.4 months. We observed a significant decrease from baseline in mean number of daily aspirations and a significant improvement in patient- and caregiver-reported outcomes following ultrasound-guided BoNT-A injections (p < 0.001 vs baseline for all comparisons) and the mean duration of the efficacy was 5.6 ± 1 months. No major treatment-related adverse events occurred and a low incidence of minor adverse events was reported. This study confirms the long-lasting efficacy and safety of ultrasound-guided BoNT-A injections for sialorrhea, regardless of the causative neurological disorder. These results should encourage the use of BoNT-A in the treatment of severe sialorrhea and highlight the role of ultrasound guidance to obtain optimal results in terms of safety and reproducible outcomes.
authors.affiliation: Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy. p.barbero@isiline.it.
authors.forename: Pierangelo
authors.initials: P
authors.lastname: Barbero
authors.affiliation: Oncology Department, Radiology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Busso
authors.affiliation: Clinical and Biological Sciences Department, Dietologic And Nutrition Department, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Tinivella
authors.affiliation: Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy.
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Artusi
authors.affiliation: Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: De Mercanti
authors.affiliation: Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy.
authors.forename: Angele
authors.initials: A
authors.lastname: Cucci
authors.affiliation: Oncology Department, Radiology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Veltri
authors.affiliation: Clinical and Biological Sciences Department, Dietologic And Nutrition Department, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Avagnina
authors.affiliation: ALS Center, "Rita Levi Montalcini" Department of Neuroscience, Neurology II, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Calvo
authors.affiliation: ALS Center, "Rita Levi Montalcini" Department of Neuroscience, Neurology II, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Chio'
authors.affiliation: Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Durelli
authors.affiliation: Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy.
authors.forename: Marinella
authors.initials: M
authors.lastname: Clerico
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000494:pharmacology*; D003680:Deglutition Disorders / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009498:Neurotoxins / Q000008:administration & dosage / Q000494:pharmacology*; D017063:Outcome Assessment, Health Care; D010306:Parotid Gland; D012798:Sialorrhea / Q000188:drug therapy* / Q000209:etiology; D013363:Submandibular Gland; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D009498:Neurotoxins; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin; Drooling; Dysphagia; Neurological diseases; Sialorrhea; Ultrasound-guided botulinum toxin-A injections