Botulinum Injected into the Salivary Glands Relieves Excessive Saliva in ALS

abstract & commentary

Source: Geiss R, et al. Injections of botulinum toxin A into the salivary glands improve sialorrhoea in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2000;69: 121-123.

Patients suffering the late stages of bulbar amyotrophic lateral sclerosis (ALS) frequently develop chronic, excessive sialorrhoea. Similar problems also may distress patients with pseudobulbar palsy due to cerebral vascular disease or, occasionally, multiple sclerosis. Geiss and associates treated five patients with bulbar ALS and disabling sialorrhoea. They used Botulinum toxin A, which prevents acetylcholinesterase release at appropriate motor and autonomic nerve terminals. The drug has found worth in treating other autonomic disorders but in this case the target consisted of the salivary glands. Both parotid glands were injected and reinjected two weeks later if the initial response was not sufficient. The submandibular glands were only injected if the parotid injections had been unsuccessful. Effect was quantified by checking the patients’ reduction of paper towels following treatment as well as grossly evaluating their own response between none, moderate, or markedly successful. Salivary secretion was measured by technetium-99m pertechnetate before the first Botox dose and two weeks after the injection started. Sialorrhea declined within 3-5 days after the first administration. Three patients showed a "marked improvement" after treatment and reported a higher quality of life. Another had moderate improvement and the fifth reported no help. This last individual apparently had a rapid downhill course of his total disease.

Geiss et al report several parallel findings. One was that the salivary secretion of all of the subjected ALS patients was less than half of the normal flow. (Possibly, this reflected a loss of salivary stimulation because of their limited oral food stimulus).

Commentary

This is a useful report because it shows a possibility of reducing excess salivation in patients with oral cancers, traumatic facial injury, cranial polyneuropathy, and, perhaps other disturbances. How long the benefit will last is as yet hard to tell. —fred plum