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A systematic review of the perspectives of botulinum toxin use on the quality of life of neurological patients with drooling

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Abstract

Objective

To investigate the effectiveness of botulinum toxin in the salivary glands of patients with neurological impairment and drooling and its impact on the quality of life.

Materials and methods

This systematic review was registered with the International Prospective Register of Systematic Reviews (CRD 42,023,435,242) and conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. An electronic search was performed in the PubMed/MEDLINE, Embase, Scopus, Cochrane Library, and clinical trial databases until August 2023, no language restriction. Cohort studies and randomized clinical trials of patients diagnosed with drooling and neurological impairment who used botulinum toxin on the salivary gland were included, which evaluated subjective quality of life parameters. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist and Risk of Bias 2 tools. The certainty of the evidence was analyzed using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results

Eight studies involving 317 patients were included. All studies, through subjective parameters, suggested the effectiveness of botulinum toxin in reducing drooling, resulting in an improvement in the quality of life. Three studies demonstrated improvements in swallowing and four in cases of respiratory diseases. Two clinical trials had a high risk of bias, whereas one had low risk. The five cohort studies that were evaluated had a high risk of bias. The certainty of the evidence was considered low.

Conclusions

Based on the patient/caregivers’ perception of improvement in drooling, dysphagia, and respiratory symptoms, it can be inferred that botulinum toxin application reduces subjective drooling in neurologically compromised patients. Its impact contributes to the general well-being and quality of life.

Clinical relevance

Injection of botulinum toxin into the salivary glands can be considered an alternative technique to surgical or medicinal approaches in reducing drooling. It is effective, less invasive and without significant side effects. It promotes a positive impact on the well-being and quality of life of neurological patients.

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Data availability

No datasets were generated or analysed during the current study.

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Authors and Affiliations

  1. Faculdade de Odontologia, Universidade de Pernambuco, Campus Santo Amaro, Pernambuco, Brasil

    Michelle Almeida Silva, Márcia Maria Fonseca da Silveira, Bruna Rafaele Vieira Pedrosa, Rebeka Thiara Nascimento Thiara dos Santos, Zilda Betânia Barbosa Medeiros de Farias & Ana Paula Veras Sobral

  2. Programa de Pós-Graduação em Odontologia, Universidade de Pernambuco, Pernambuco Recife (PE), Brasil

    Michelle Almeida Silva, Márcia Maria Fonseca da Silveira, Bruna Rafaele Vieira Pedrosa, Rebeka Thiara Nascimento Thiara dos Santos, Zilda Betânia Barbosa Medeiros de Farias & Ana Paula Veras Sobral

  3. Rua Coronel Barata 52, João Pessoa, 58025-300, Paraíba, Brasil

    Michelle Almeida Silva

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Contributions

Study conception and design: Michelle Almeida Silva and Zilda Betânia Barbosa Medeiros de Farias. Material preparation, data collection and analysis: Michelle Almeida Silva, Márcia Maria Fonseca da Silveira, Bruna Rafaele Vieira Pedrosa, Zilda Betânia Barbosa Medeiros de Farias, Rebeka Thiara Nascimento dos Santos and Ana Paula Veras Sobral. First draft of the manuscript: Michelle Almeida Silva, Márcia Maria Fonseca da Silveira, Bruna Rafaele Vieira Pedrosa, Zilda Betânia Barbosa Medeiros de Farias, Rebeka Thiara Nascimento dos Santos and Ana Paula Veras Sobral. Final approval of the manuscript: Michelle Almeida Silva, Márcia Maria Fonseca da Silveira, Bruna Rafaele Vieira Pedrosa, Zilda Betânia Barbosa Medeiros de Farias, Rebeka Thiara Nascimento dos Santos and Ana Paula Veras Sobral.

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Correspondence to Michelle Almeida Silva.

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Silva, M.A., da Silveira, M.M.F., Pedrosa, B.R.V. et al. A systematic review of the perspectives of botulinum toxin use on the quality of life of neurological patients with drooling. Clin Oral Invest 28, 322 (2024). https://doi.org/10.1007/s00784-024-05718-y

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