Botox - the Magic Panacea?

Botox: The Magical Panacea?

L. Spevack, Dr. M. Wiseman, Dr. M. Panisset (Montreal, Quebec, Canada)

Objective: We report here our initial experience with this treatment.

Background: Sialorrhea is a problem in up to 40% of patients with Parkinson's disease (PD). As it affects patients in their more advanced stages of the disease, treating sialorrhea with Anticholinergics poses a threat for hallucinations and confusion. Injections of botulinum toxin in salivary glands have been proposed as a potential treatment.

Methods: We injected 12 patients with PD with disturbing sialorrhea in either their parotid or their submandibular glands. We measured unstimulated salivary production, pH and buffering capacity and submitted patients to a questionnaire pre and 1 month post injections.

Results: Patients were 71.3± 12.3 years of age, had had PD for 8.8 ± 6.0 years and were at a Hoehn and Yahr stage of 3.5 ± 1.2. At baseline, salivary production was 0.29 ± 0.25 g/min (normal = 1.1 ± 0.7), consistency was 2.4 ± 0.8 (normal = 3), pH was 6.0 ± 0.5 (normal = 6.8 to 7.8) and buffering capacity of saliva was 3.8 ± 2.5 (normal =10 to 12). Patients received a mean of 86.7 ± 22.3 MU of BTXA. There was no significant difference in salivary production, consistency, pH and buffering capacity of saliva. There was a significant decrease in the severity of sialorrhea (z= -2.692, p=0.007) and in social handicap (z= -2.203, p= 0.028) as measured on a 1 to 5 point scale, but no difference on a quality of life scale (PDQ39).

Conclusions: This pilot study shows that BTXA is efficacious in decreasing sialorrhea and its social impact. Salivary production does not correlate to the subjective evaluation. Patients with PD have too little of a poor quality saliva that could affect their teeth. A double-blind placebo controlled study is important to clarify these issues.