Botulinum toxin for the treatment of sialorrhoea in ALS: serious side effects of a transductal approach

We have read with interest the article by Giess et al ,1 which showed that botulinum toxin A (BoNT/A) might be a new treatment option for sialorrhoea in patients with bulbar palsy. We have recently conducted a similar study which was interrupted due to serious side effects. In September 1998 we injected 25 MU Botox into the parotid glands of a 59 year old women who had ALS with pronounced bulbar palsy. We noticed a reduction of the sialorrhoea but facial weakness on the left side worsened significantly. After this experience we developed a protocol for the treatment of sialorrhoea in patients with ALS with bulbar palsy by retrograde injection of BoNT/A through the salivary duct into the salivary glands. We chose the retrograde way of administration of BoNT/A for this pilot study because we thought that this technique would avoid facial weakness. After informed consent the patients received 12.5 mouse units (MU) BoNT/A (BotoxR) retrogradly into each parotid and sublingual gland from a small catheter inserted into the salivary duct. Neurological examination and quantification … Dr M Naumann naumann{at}mail.uni-wuerzburg.de