Jost Wolfgang H, Bäumer Tobias, Laskawi Rainer, Slawek Jaroslaw, Spittau Björn, Steffen Armin, Winterholler Martin, Bavikatte Ganesh
Parkinson-Klinik Ortenau, Wolfach, Germany.
Paediatric and Adult Movement Disorders and Neuropsychiatry, Institut of Neurogenetics, University of Lübeck, Lübeck, Germany.
Neurol Ther. 2019 Dec;8(2):273-288. doi: 10.1007/s40120-019-00155-6. Epub 2019 Sep 21.
Botulinum neurotoxin (BoNT) is considered the treatment of choice for various symptoms and diseases such as focal dystonia and focal spasticity. The effects of BoNT on the salivary glands have also been known for years, but their use was limited because of a lack of approval studies. Now the indication of sialorrhea is approved in some countries for incobotulinumtoxinA, such as the USA and Europe, and therapy could also become the treatment of choice. According to the pivotal study, a dose of 100 units of incobotulinumtoxinA, which is divided into the parotid and submandibular glands, is recommended. RimabotulinumtoxinB is approved in the USA only. To define the value of this therapy, we must consider anatomy, physiology, and available therapies. Therapy includes conservative measures such as functional dysphagia therapy, oral or transdermal application of anticholinergics, and, in selected cases, radiotherapy and surgical procedures. A combination of different approaches is optional. On the basis of the evidence and clinical experience, BoNT injections will be the first line of pharmacotherapy for chronic sialorrhea.
肉毒杆菌神经毒素（BoNT）被认为是治疗各种症状和疾病（如局灶性肌张力障碍和局灶性痉挛）的首选方法。肉毒杆菌神经毒素对唾液腺的作用多年来也为人所知，但由于缺乏批准研究，其应用受到限制。现在，在美国和欧洲等一些国家，注射用A型肉毒毒素治疗流涎症已获批准，该疗法也可能成为首选治疗方法。根据关键研究，建议将100单位的注射用A型肉毒毒素分注于腮腺和颌下腺。注射用B型肉毒毒素仅在美国获得批准。为了确定这种疗法的价值，我们必须考虑解剖学、生理学和现有的治疗方法。治疗方法包括保守措施，如功能性吞咽困难治疗、口服或经皮应用抗胆碱能药物，以及在特定情况下进行放射治疗和外科手术。可以选择不同方法的组合。根据现有证据和临床经验，肉毒杆菌神经毒素注射将作为慢性流涎症药物治疗的一线方法。
