Costa João, Rocha Maria Luz, Ferreira Joaquim, Evangelista Teresinha, Coelho Miguel, de Carvalho Mamede
Serviço de Neurologia (Piso 7), Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa.
J Neurol. 2008 Apr;255(4):545-50. doi: 10.1007/s00415-008-0738-5. Epub 2008 Feb 19.
Sialorrhea is a disabling problem in bulbaronset amyotrophic lateral sclerosis (ALS). Botulinum toxin (BTX) type A and B have been proposed as alternatives to traditional treatments.
To evaluate the efficacy and safety of BTX type B in the treatment of sialorrhea in patients with bulbar-onset ALS.
Open-label prospective study of BTX type B injections in parotids (1000 U) and submandibular (250 U) glands using anatomic landmarks. Primary outcome was rate of responders (improvement > 50% on visual analogue scales (VAS) of severity and disability of sialorrhea) 1 month post-treatment. Other outcomes included subjective (drooling and quality of daily living questionnaires) and objective (cotton roll weights and number of paper handkerchiefs used) evaluations. Safety evaluations included questionnaires regarding brain stem symptoms.
Sixteen ALS patients were included. At 1 month the rate of responders was 75% with a mean reduction of 70% in severity and disabling VASs. Fifteen patients (94 %) reported some benefit with drooling reduction. In objective measurements there was a reduction over 60 % in saliva production and in the number of handkerchiefs used. Onset of effect occurred within 3 days. Most patients reported better quality of living. The most frequent side-effects were viscous saliva, local pain, chewing weakness and respiratory infection. There were no changes in blood pressure or cardiac rate. At 3 months, there was still a positive effect in all outcomes. All patients except one manifested their willingness to repeat treatment.
Anatomic guided BTX type B injections seem effective and safe to treat sialorrhea in bulbar-onset ALS.
流涎是延髓起病的肌萎缩侧索硬化症（ALS）中的一个致残问题。A型和B型肉毒杆菌毒素（BTX）已被提议作为传统治疗方法的替代方案。
评估B型肉毒杆菌毒素治疗延髓起病的ALS患者流涎的疗效和安全性。
采用解剖标志对腮腺（1000单位）和颌下腺（250单位）进行B型肉毒杆菌毒素注射的开放标签前瞻性研究。主要结局是治疗后1个月时的反应者率（流涎严重程度和残疾程度的视觉模拟量表（VAS）改善>50%）。其他结局包括主观评估（流口水和日常生活问卷）和客观评估（棉球重量和使用的纸巾数量）。安全性评估包括关于脑干症状的问卷。
纳入了16例ALS患者。1个月时，反应者率为75%，严重程度和残疾VAS平均降低70%。15例患者（94%）报告流口水减少有一定益处。客观测量显示唾液分泌量和使用的手帕数量减少了60%以上。效果在3天内出现。大多数患者报告生活质量有所改善。最常见的副作用是唾液黏稠、局部疼痛、咀嚼无力和呼吸道感染。血压和心率无变化。3个月时，所有结局仍有积极效果。除1例患者外，所有患者都表示愿意重复治疗。
解剖学引导下的B型肉毒杆菌毒素注射治疗延髓起病的ALS患者流涎似乎有效且安全。
