Semin Neurol 2016; 36(01): 020-028
DOI: 10.1055/s-0035-1571214
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Botulinum Toxin Treatment of Autonomic Disorders: Focal Hyperhidrosis and Sialorrhea

Christine Hosp
1  Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
,
Markus K. Naumann
2  Department of Neurology, Klinikum Augsburg, Augsburg, Germany
,
Henning Hamm
1  Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
11 February 2016 (online)

Abstract

Primary focal hyperhidrosis is a common autonomic disorder that significantly impacts quality of life. It is characterized by excessive sweating confined to circumscribed areas, such as the axillae, palms, soles, and face. Less frequent types of focal hyperhidrosis secondary to underlying causes include gustatory sweating in Frey's syndrome and compensatory sweating in Ross' syndrome and after sympathectomy. Approval of onabotulinumtoxinA for severe primary axillary hyperhidrosis in 2004 has revolutionized the treatment of this indication. Meanwhile further type A botulinum neurotoxins like abobotulinumtoxinA and incobotulinumtoxinA, as well as the type B botulinum neurotoxin rimabotulinumtoxinB are successfully used off-label for axillary and various other types of focal hyperhidrosis. For unexplained reasons, the duration of effect differs considerably at different sites. Beside hyperhidrosis, botulinum neurotoxin is also highly valued for the treatment of sialorrhea affecting patients with Parkinson's disease, cerebral palsy, amyotrophic lateral sclerosis, motor neuron disease, and other neurologic conditions. With correct dosing and application, side effects are manageable and transient.