Objective: Investigate the safety and efficacy of botulinum toxin type A in Parkinson´s disease and parkinsonism patients affected by sialorrhea

Background: Sialorrhea is excessive salivation associated with neurological disorders. About 80% of adults with Parkinson’s disease have been reported to have sialorrhea  . Excessive production and drooling of saliva may impair mastication and speech and is associated with a poor quality of life.
Pharmacological agents such as Botulinum toxins, glycopyrrolate, scopolamine and benztropine have been shown in several individual clinical trials to be useful in treating sialorrhea

Method: We have collected data  from 138 patients followed -up from 2015 to 2020 at Hospital Infanta Sofia,  with PD and atypical parkinsonism that recive botulinum injections to treat sialorrhea. We recorded age , gender , diagnosis , botulinum toxin dosage , frecuency of injections anf adverse effects. We  use  to measure drooling  the Sialorrhea Clinical Scale for PD (SCS-PD) .Is specifically designed for assessing sialorrhea-related discomfort in PD patients, and its validity has been preliminarily demonstrated through saliva volume measurements in PD patients and healthy volunteers. Consists of seven questions assessing drooling severity and frequency as well as social and functional impairment. It is easily administered, and therefore has the potential to be adopted as one of the routine clinical scales for measuring sialorrhea-related discomfort in PD patients.
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Results: PD was diagnosed in 78 patients , Supranuclear Palsy in 30 patients , 17 with Multisystem atrophy and 13 with Lewy body dementia. No diferences were observed by gender wih 70 mles and 68 female. The age range between 63-85( mean 74) . The dose was from 20-40 IU of botulinum toxin type A in each parotid gland . Initialy patients required treatment every 3 months , but in 50 patients we could administer treatment every 6 months. 
We reduce the (SCS-PD) scores in 6-8 points from the baseline, prior to injections, and this improvement lasts during the 5 years follow -up. The major efect reported was related to the social impact of drooling,
No relevant adverse effects have been reported

Conclusion: Botulinm toxin seems to be safe and effective in PD and atypical parkinsonism patients, and the benefit lasts  at least 5 years

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MDS Abstracts - https://www.mdsabstracts.org/abstract/botulinum-toxin-injections-for-sialorrhea-in-parkinsons-disease-and-parkinsonism-5-years-follow-up/