Experience with a new botulinum toxin type A (BTA) formulation in the treatment of sialorrhea

Purpose: We report our initial experience with a new BTA formulation free of complex proteins in the treatment of sialorrhea. Our aim was to collect data on the safety and efficacy profile of Xeomin injections in saliva glands in a mixed population in neurorehabilitation.

Methods: Six patients with neurogenic dysphagia and clinical significant sialorrhea (idiopathic Parkinson's disease=2, multiple system atrophy=1 and stroke=3) underwent bilateral parotis injections with 50 units Xeomin in each gland (dilution: 2ml normal saline per 100 unit) using sonographic guidance. Patients were evaluated two to three month post injection. Objective measurement of saliva with dental rolls, a clinical score (drooling score) and subjective changes concerning sialorrhea were used to evaluate the magnitude and duration of effects.

Results: Two weeks following injection all patients showed objective (>50% reduction in saliva production), subjective (6/6 relief of symptoms) and score (6/6) improvements. No adverse events were recorded. Subjective improvements were recognized within one week after injection. Subjective relief of symptoms lasts for one to three month.

Conclusion: These pilot-study in six patients with sialorrhea suggest that sono-guided injections of 100 unit Xeomin in both parotis glands are safe and effective in the treatment of drooling in neurogenic dysphagia. However, carefully designed placebo controlled studies in patients with sialorrhea are required to address more specific questions related to patient selection, appropriate dose and product specific differences of BTA formulations available.