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Jost WH, Bäumer T, Bevot A, Birkmann U, Buhmann C, Grosheva M, Guntinas-Lichius O, Laskawi R, Paus S, Pflug C, Schroeder AS, Spittau B, Steffen A, Wilken B, Winterholler M, Berweck S. Botulinum neurotoxin type A in the interdisciplinary treatment of sialorrhea in adults and children-update and practice recommendations. Front Neurol 2023; 14:1275807. [PMID: 38162447 PMCID: PMC10757066 DOI: 10.3389/fneur.2023.1275807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
Sialorrhea is defined as a chronic excessive flow of saliva from the mouth, often with adverse consequences for health and quality of life of patients. In addition to currently used non-drug treatment and systemic drugs, intraglandular Botulinum Neurotoxin A (BoNT/A) injections have been examined in case studies, controlled trials and clinical practice. Two pivotal Phase III trials recently led to market approval in the USA and EU for IncobotulinumtoxinA [Xeomin®, IncoBoNT/A, Clostridium botulinum neurotoxin type A (150 kD), free from complexing proteins, Merz Pharmaceuticals GmbH] for treatment of chronic sialorrhea in adults and pediatric patients. This review provides a multidisciplinary approach to discuss the current state of sialorrhea therapy as well as benefits and current limitations of BoNT/A injections. A consensus regarding treatment recommendations made available to physicians in Germany in 2022 has now been updated here for presentation to an international audience. This review provides a framework including a flow chart for patient selection, recommendations for dosing and the injection process, as well as a discussion of therapeutic goals, long-term benefits and safety aspects. This review is aimed at supporting physicians in developing multidisciplinary and individualized treatment approaches to achieve optimal benefits for patients.
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Affiliation(s)
| | - Tobias Bäumer
- Institute of Systemic Motor Science, CBBM, University of Lübeck, Lübeck, Germany
| | - Andrea Bevot
- Department of Neuropediatrics and Developmental Medicine, University Children’s Hospital Tübingen, Tübingen, Germany
| | - Ulrich Birkmann
- Department of Neurology, Schluckambulanz, GFO Clinics Troisdorf, Troisdorf, Germany
| | - Carsten Buhmann
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Grosheva
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | | | - Rainer Laskawi
- Department of Otorhinolaryngology, University Hospital Göttingen, Göttingen, Germany
| | - Sebastian Paus
- Department of Neurology, GFO Clinics Troisdorf, Troisdorf, Germany
| | - Christina Pflug
- Department of Voice, Speech and Hearing Disorders, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - A. Sebastian Schroeder
- Clinic for Child Neurology and Social Pediatrics, Child Center Maulbronn, Maulbronn, Germany
| | - Björn Spittau
- Anatomy and Cell Biology, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Armin Steffen
- Department for Otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Bernd Wilken
- Department of Pediatric Neurology, Klinikum Kassel, Kassel, Germany
| | - Martin Winterholler
- Department of Neurology, Sana Hospital Rummelsberg, Nuremberg/Schwarzenbruck, Germany
| | - Steffen Berweck
- Specialist Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Clinic, Vogtareuth, Germany
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Bergmans B, Clark V, Isaacson SH, Bäumer T. Recommendations for a paradigm shift in approach to increase the recognition and treatment of sialorrhea in Parkinson's disease. Clin Park Relat Disord 2023; 9:100223. [PMID: 38021341 PMCID: PMC10643485 DOI: 10.1016/j.prdoa.2023.100223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/29/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Sialorrhea, or drooling, is defined as excessive saliva accumulation and unwanted loss of saliva from the mouth or over the tongue and into the pharynx. It constitutes one of the most frequent and bothersome complaints of patients with Parkinson's disease (PD), affecting up to 84% of them. Sialorrhea is a distressing and challenging condition that may result in social isolation, embarrassment, depression, skin infections, poor oral health, and aspiration pneumonia. To better understand the burden of sialorrhea on patients with PD, Parkinson's Europe carried out a worldwide patient survey which showed that sialorrhea remains an underrecognized and undertreated issue in patients with PD. This is especially problematic because effective therapeutic options are available. This article presents the results of the Parkinson's Europe Sialorrhea Survey, which were considered by a multidisciplinary panel of experts to provide recommendations for improving the awareness, diagnosis, management, and treatment of sialorrhea in patients with PD. A shift in the treatment paradigm for sialorrhea in patients with PD is emerging. It is essential to better educate patients, family members, caregivers, and healthcare professionals about sialorrhea; to engage all those involved to actively discuss sialorrhea and measure its impact on quality of life; and to recognize the role of botulinum toxin and speech and language therapy as first-line therapies.
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Affiliation(s)
- Bruno Bergmans
- Department of Neurology, AZ St-Jan Brugge-Oostende AV, Campus Brugge, 8000 Bruges, Belgium
- Department of Neurology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Veronica Clark
- Independent Researcher, Malta Parkinson’s, PO Box 17, Marsa MTP 1001, Malta
- Private Practice, UK
| | - Stuart H. Isaacson
- Parkinson’s Disease and Movement Disorders Center of Boca Raton, 951 NW 13th Street, Bldg. 5-E, Boca Raton, FL 33486, USA
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, CBBM (Building 66), Ratzeburger Allee 160, 23562 Lübeck, Germany
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