Objective: 1. Assess real‑world outcomes of Botulinum Toxin A (BoNT-A) therapy for sialorrhoea in Parkinson’s disease by evaluating changes in Drooling Severity and Frequency Scale (DSFS), EuroQol (EQ5D) and Visual Analogue Scores (VAS) scores across treatment cycles

2. Determine treatment durability, tolerability, and the value of routine monitoring in guiding longer‑term saliva‑control management.

Background: Sialorrhoea profoundly impairs quality of life in Parkinson’s. Oral treatment options are limited with increasing evidence for BoNT-A injections as a targeted treatment for Sialorrhoea.

Method: Consecutive patients referred to the Cardiff and Vale Sialorrhoea Service (S Wales, UK) from 2019 to 2024 were reviewed. Demographics, Hoehn and Yahr (H&Y) staging, DSFS and EQ5D scores including VAS were recorded. Pre‑ and post injection for each treatment cycle were noted. Changes in DSFS and VAS were analysed individually and longitudinally across successive injection cycles.

Results: 78 patients (mean age 79) generated 180 clinic encounters (attendance rate 83.9%). Non-attendance was attributable to intercurrent illness, hospitalisation, Covid-19 disruption and death; majority had H&Y stage 2 and 3. Across all visits, DSFS scores fell significantly after BoNT‑A, mean post‑injection scores on average 1.7 points lower than pre‑injection values for injections cycles 1–4 (p value of <0.001). Absolute DSFS reduction persisted and amplified modestly over the first four cycles, (from a 1.5‑point reduction at injection 1 to 2.2 points at injection 4), indicating cumulative therapeutic benefit rather than tachyphylaxis. Changes in VAS were modest, with a 1.3% improvement (p value >0.05)

Conclusion: Serial BoNT‑A therapy demonstrates a clinically meaningful and sustained reduction in sialorrhoea in an older Parkinson’s cohort. The treatment was well tolerated.

Improvements in DSFS scores were maintained—and in some cases enhanced—across multiple treatment cycles, indicating no loss of therapeutic effect over time and supporting the medium‑term efficacy of BoNT‑A.

These real‑world findings support continued commissioning of specialised sialorrhoea services and highlight the value of routine DSFS monitoring to guide and optimise iterative BoNT‑A treatment strategies

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MDS Abstracts - https://www.mdsabstracts.org/abstract/five-year-real-world-outcomes-of-botulinum-toxin-injections-for-sialorrhoea-in-parkinsons/