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Long-term follow-up of ultrasound-guided botulinum toxin-A injections for sialorrhea in neurological dysphagia

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Abstract

Literature provides reports only of a limited follow-up single injection of botulinum toxin-A (BoNT-A) in patients with sialorrhea. The aim of our study is to evaluate the long-lasting efficacy and safety of ultrasound-guided BoNT-A injections for severe sialorrhea secondary to neurological dysphagia. We enrolled 38 severe adult sialorrhea patients referred consecutively to the neurology unit and performed bilateral parotid and submandibular gland BoNT-A injections under ultrasound guidance. The outcomes of the study were reduction of sialorrhea, duration of therapeutic effect, and subjective patient- and caregiver-reported satisfaction. A total of 113 BoNT-A administrations were given during the study period with a mean duration of follow-up of 20.2 ± 4.4 months. We observed a significant decrease from baseline in mean number of daily aspirations and a significant improvement in patient- and caregiver-reported outcomes following ultrasound-guided BoNT-A injections (p < 0.001 vs baseline for all comparisons) and the mean duration of the efficacy was 5.6 ± 1 months. No major treatment-related adverse events occurred and a low incidence of minor adverse events was reported. This study confirms the long-lasting efficacy and safety of ultrasound-guided BoNT-A injections for sialorrhea, regardless of the causative neurological disorder. These results should encourage the use of BoNT-A in the treatment of severe sialorrhea and highlight the role of ultrasound guidance to obtain optimal results in terms of safety and reproducible outcomes.

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Authors and Affiliations

  1. Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy

    Pierangelo Barbero, Carlo Alberto Artusi, Stefania De Mercanti, Angele Cucci, Luca Durelli & Marinella Clerico

  2. Oncology Department, Radiology Unit, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy

    Marco Busso & Andrea Veltri

  3. Clinical and Biological Sciences Department, Dietologic And Nutrition Department, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy

    Marco Tinivella & Paolo Avagnina

  4. ALS Center, “Rita Levi Montalcini” Department of Neuroscience, Neurology II, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy

    Andrea Calvo & Adriano Chio’

Authors
  1. Pierangelo Barbero
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  2. Marco Busso
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  3. Marco Tinivella
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  8. Paolo Avagnina
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  9. Andrea Calvo
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Correspondence to Pierangelo Barbero.

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The authors declare no conflict of interest.

Ethical standard

Approval was obtained from the local ethical standards committee on human experimentation and written informed consent obtained from all subjects before enrollment. The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Barbero, P., Busso, M., Tinivella, M. et al. Long-term follow-up of ultrasound-guided botulinum toxin-A injections for sialorrhea in neurological dysphagia. J Neurol 262, 2662–2667 (2015). https://doi.org/10.1007/s00415-015-7894-1

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  • DOI: https://doi.org/10.1007/s00415-015-7894-1

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