Møller E, Daugaard D, Holm O, Winge K, Bardow A, Lykkeaa J, Belhage B, Bakke M
Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Acta Neurol Scand. 2015 Jan;131(1):51-7. doi: 10.1111/ane.12309. Epub 2014 Oct 1.
To investigate efficacy, saliva flow, and composition in repeated BoNT-B treatments of drooling.
Seventeen neurological patients (median 66 years), referred for treatment of drooling participated in this observational study. Median total doses of 4000 units botulinum toxin type B (BoNT-B, Neurobloc(®)) were injected with at least 3 months intervals into parotid and submandibular glands using ultrasound guidance. Measures of drooling and saliva collection for analysis were obtained before treatment, and 6, 12, and eventually 18 weeks after.
Number of treatment series in each patient was 1-7. Compared to baseline, saliva flow rate and drooling were reduced 30-70% 6 weeks after treatment in the first series, while sodium, chloride, and total protein increased 20-80% (t-tests; P < 0.05). After 12 weeks, drooling was still significantly reduced, saliva flow tended to be, and saliva composition was back to baseline. Frequent side effects were viscous saliva and dry mouth. Due to fading effect in eight patients, individual decisions were taken to change from BoNT-B to BoNT-A. Similarly, the outcome was significantly reduced over time in six patients completing five subsequent BoNT-B treatment series (ANOVA; P < 0.05).
In the first series, BoNT-B treatment resulted in marked reduction of drooling and saliva flow rate with some relapse after 12 weeks. The viscous saliva was ascribed to increased total protein content and compensatory mechanisms related to ß-adrenergic receptor-specific actions. With patients needing long-term treatment, it should be noted that the efficacy of repeated BoNT-B may fade with time.
研究重复注射肉毒杆菌毒素B（BoNT-B）治疗流涎症的疗效、唾液流量及成分。
17例因流涎症前来治疗的神经科患者（年龄中位数66岁）参与了这项观察性研究。在超声引导下，以至少3个月的间隔，向腮腺和颌下腺注射总计4000单位的B型肉毒杆菌毒素（BoNT-B，Neurobloc(®)）。在治疗前、治疗后6周、12周以及最终18周时，对流涎情况进行测量并收集唾液用于分析。
每位患者的治疗疗程数为1 - 7个。与基线相比，在首个疗程治疗后6周，唾液流速和流涎量降低了30% - 70%，而钠、氯和总蛋白含量增加了20% - 80%（t检验；P < 0.05）。12周后，流涎仍显著减少，唾液流速趋于减少，唾液成分恢复至基线水平。常见的副作用是唾液黏稠和口干。由于8例患者出现疗效减退，因此个别决定从BoNT-B改为BoNT-A。同样，在完成5个后续BoNT-B治疗疗程的6例患者中，随着时间推移，治疗效果显著降低（方差分析；P < 0.05）。
在首个疗程中，BoNT-B治疗使流涎和唾液流速显著降低，但12周后出现一定程度的复发。唾液黏稠归因于总蛋白含量增加以及与β - 肾上腺素能受体特异性作用相关的代偿机制。对于需要长期治疗的患者，应注意重复使用BoNT-B的疗效可能会随时间减退。
