Frontiers in Neurology (Dec 2023)

Botulinum neurotoxin type A in the interdisciplinary treatment of sialorrhea in adults and children—update and practice recommendations

  • Wolfgang H. Jost,
  • Tobias Bäumer,
  • Andrea Bevot,
  • Ulrich Birkmann,
  • Carsten Buhmann,
  • Maria Grosheva,
  • Orlando Guntinas-Lichius,
  • Rainer Laskawi,
  • Sebastian Paus,
  • Christina Pflug,
  • A. Sebastian Schroeder,
  • Björn Spittau,
  • Armin Steffen,
  • Bernd Wilken,
  • Martin Winterholler,
  • Steffen Berweck

DOI
https://doi.org/10.3389/fneur.2023.1275807
Journal volume & issue
Vol. 14

Abstract

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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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