Objective: Evaluate the efficacy and tolerance of Botulinum Toxin A (BoNT A) in managing sialorrhoea in People with Parkinsons (PwP)

Assess impact on quality of life in PwP receiving BoNT A injections

Background: Sialorrhoea is a distressing symptom of Parkinson’s significantly affecting quality of life. Traditional treatment involves drugs with high anticholinergic burden and side-effects especially for frailer adults. Botulinum neurotoxin A (BoNT A) injection is a recent proven treatment for sialorrhoea.

Method: We incorporated BoNT A treatment into our Parkinson’s service. Injection clinics were initiated from June 2021. Patients were screened using the Drooling Frequency and Severity scale (DSFS) questionnaire (scoring ≥6 offered treatment). Patients were counselled by a dedicated nurse regarding procedure. A bespoke patient information leaflet was developed.

We used a total of 100 units of BoNT A into submandibular and parotid glands with ultrasound guidance (a lower dose of 50 units was initially tried). Patients were given a phone call 4-6 weeks post procedure to assess progress and data regarding DSFS and quality of life (EQ-5D questionnaire) were collected. The effect of the injection being temporary treatment is repeated after 4 months.

Results: Data was collected from June 2021-June 2022. We performed a total of 42 interventions in 28 patients (average age 76.7 years, clinical frailty scale, 6). With 50 units of BoNT A, 33% of interventions yielded improvement confirmed by DSFS and 28% by EQ-5D. This was in contrast of 75% improvement on DSFS and 35% improvement on EQ-5D when 100 units was used. No significant side effects were reported.

Conclusion: Use of BoNT A was found to be an efficacious, well tolerated and safe treatment in a cohort of frail older people with Parkinsons, pivotal trial involved a relatively younger cohort.

There was a trend towards improvement in quality of life in our limited sample size, particularly with the standard recommended dosage.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/is-a-parkinsons-sialorrhoea-service-effective/