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:10.3389/fneur.2023.1275807

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

Front Neurol. 2023 Dec 13:14:1275807. doi: 10.3389/fneur.2023.1275807. eCollection 2023.

Authors

Wolfgang H Jost¹, Tobias Bäumer², Andrea Bevot³, Ulrich Birkmann⁴, Carsten Buhmann⁵, Maria Grosheva⁶, Orlando Guntinas-Lichius⁷, Rainer Laskawi⁸, Sebastian Paus⁹, Christina Pflug¹⁰, A Sebastian Schroeder¹¹, Björn Spittau¹², Armin Steffen¹³, Bernd Wilken¹⁴, Martin Winterholler¹⁵, Steffen Berweck¹⁶

Affiliations

¹ Parkinson-Klinik Ortenau, Wolfach, Germany.
² Institute of Systemic Motor Science, CBBM, University of Lübeck, Lübeck, Germany.
³ Department of Neuropediatrics and Developmental Medicine, University Children's Hospital Tübingen, Tübingen, Germany.
⁴ Department of Neurology, Schluckambulanz, GFO Clinics Troisdorf, Troisdorf, Germany.
⁵ Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
⁶ Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany.
⁷ Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.
⁸ Department of Otorhinolaryngology, University Hospital Göttingen, Göttingen, Germany.
⁹ Department of Neurology, GFO Clinics Troisdorf, Troisdorf, Germany.
¹⁰ Department of Voice, Speech and Hearing Disorders, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
¹¹ Clinic for Child Neurology and Social Pediatrics, Child Center Maulbronn, Maulbronn, Germany.
¹² Anatomy and Cell Biology, Medical School OWL, Bielefeld University, Bielefeld, Germany.
¹³ Department for Otorhinolaryngology, University of Lübeck, Lübeck, Germany.
¹⁴ Department of Pediatric Neurology, Klinikum Kassel, Kassel, Germany.
¹⁵ Department of Neurology, Sana Hospital Rummelsberg, Nuremberg/Schwarzenbruck, Germany.
¹⁶ Specialist Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Clinic, Vogtareuth, Germany.

Abstract

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.

Keywords: BoNT/A; IncobotulinumtoxinA; botulinum neurotoxin type A; botulinum toxin; hypersalivation; practice recommendations; quality of life; sialorrhea.

Publication types

Review

Grants and funding

Merz Therapeutics supported the medical writing financially. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication.