Efficacy of Incobotulinumtoxin Type A (Xeomin®) in the Management of Sialorrhea in Neurodegenerative Diseases

Abstract

Introduction: One of the symptoms of two very common and serious neurodegenerative diseases such as Amyotrophic Lateral Sclerosis and Parkinson’s disease is sialorrhea. It can cause macerations and fissures in perioral region, halitosis, dysarthria, aspiration penumonia, asphyxiation and patient’s awkwardness. Management can be conservative (medical therapy using anticholinergic drugs) or more invasive (surgery with excision of salivary glands, duct’s ligation and transposition). Botulinum toxin A is a non invasive and poor side effects alternative. Aim of this study is to examine therapeutic resources for sialorrhea in Amyotrophic Lateral Sclerosis and Parkinson’s disease, by objective and subjective evaluation. Materials and methods: 20 patients with sialorrhea caused by Parkinson’s disease (10 patients) and ALS (10 patients). Incobotulinum toxin A (XEOMIN®, Merz Pharma), was injected under ultrasound guide in the submandibular and parotid glands. At t0 (pre-injection), t1 (30 days later), t2 (90 days later), t3 (120 days later), t4 (150 days later) and t5 (180 days later, only in PD group) we submitted Visual Analogue Scale (VAS) to estimated the level of salivation (1 was the best state and 10 the worst state), Gauze’s test to perform the weighed of the gauze after 1 minute and Sugar lump’s test to evaluate time necessary for melting. Results: In Parkinson’s and ALS group gauze’s test, sugar lump’s test and VAS improved until 6 months (PD group) and 5 months (ALS group), with p<0,05. Conclusion: This study concludes that therapeutic resource with Botulinum toxin A is an efficient treatment option for sialorrhea in patients with ALS and PD.