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Long-lasting benefits of botulinum toxin type B in Parkinson’s disease-related drooling

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Abstract

Purpose

To investigate the safety, efficacy and effectiveness of botulinum toxin type-B (BTX-B) injections into the parotid glands to reduce drooling in Parkinson’s disease (PD) subjects.

Methods

A double-blind, randomised, placebo-controlled study enrolled 36 advanced phase PD subjects who complained of disabling drooling. Patients received either 4000U BTX-B or placebo. Anatomically guided injections were performed. Outcome measures were chosen to assess both the subjective feeling of improvement (i. e. the Drooling Severity and Frequency Scale, DSFS, visuo-analogic ratings of familial distress, VAS-FD, and social distress, VAS-SD) and objective saliva reduction (saliva production over five minutes was checked by weighing dental rolls). The Global Impression Score (GIS) was also applied, rating improvement from 0 to 3.

Results

One month after injections, BTX-B patients showed a meaningful improvement in almost all subjective outcomes. Two-way analysis of variance gave a significant time × treatment effect, F-value being 52.5 (p < 0.0001) for DS-FS, 23.2 (p < 0.0001) for VAS-FD, 29 (p < 0.0001) for VAS-SD, and 28.9 (p < 0.0001) for UPDRSADL drooling item score. All BTX-B subjects declared sialorrhea reduction of any kind (moderate for 44.4 % cases, and dramatic for 33.3 % subjects), at variance with 61.1 % controls who denied any benefit from treatment. (Chi-square = 22.9; p < 0.0001). When present, benefits lasted on average 19.2 ± 6.3 weeks in the BTX-B group compared to 6.7 ± 1.4 weeks in controls (T-value: 26.4; p < 0.0001).

Conclusions

BTXB represents a safe and efficacious tool for the management of PDrelated drooling, ensuring a longlasting waning of this disabling symptom.

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Authors and Affiliations

  1. Clinica Neurologica, Dipartimento di Neuroscienze, Università Politecnica delle Marche, Az Ospedaliero Universitaria, “Ospedali Riuniti”, Ancona, Italy

    Giovanni Lagalla M.D. & Leandro Provinciali M.D.

  2. Clinica di Neuroriabilitazione, Dipartimento di Neuroscienze, Università Politecnica delle Marche, Az Ospedaliero Universitaria, “Ospedali Riuniti”, Ancona, Italy

    Marzia Millevolte M.D., Marianna Capecci M.D. & Maria Gabriella Ceravolo M.D.

Authors
  1. Giovanni Lagalla M.D.
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  2. Marzia Millevolte M.D.
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  3. Marianna Capecci M.D.
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  4. Leandro Provinciali M.D.
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  5. Maria Gabriella Ceravolo M.D.
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Corresponding author

Correspondence to Giovanni Lagalla M.D..

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Lagalla, G., Millevolte, M., Capecci, M. et al. Long-lasting benefits of botulinum toxin type B in Parkinson’s disease-related drooling. J Neurol 256, 563–567 (2009). https://doi.org/10.1007/s00415-009-0085-1

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  • DOI: https://doi.org/10.1007/s00415-009-0085-1

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