the total dose of Dysport administered per patient was 500 MU per 2.5 mL of saline. The appropriate conversion factor of Botox:Dysport varies from 1:3 to 1:6 MU in studies using these agents in dystonia. 7 The different potency of these agents in treating sialorrhea in PD is unknown. Therefore, given a conversion factor of 1:6 MU, our dosage of 80 MU appeared to be similar to that used in the report by Nó brega et al. 2 Moreover, our study showed that BTX-A decreased the volume and the frequency of sialorrhea, as demonstrated in other studies, 5,8 whereas in the study by Nó brega et al., only the volume was reduced. We agree with Nó brega et al. 9 on the possibility that in patients with PD, sialorrhea may be secondary to swallowing disorders, although in our study, the effect of the toxin on drooling frequency was less relevant than that on the volume, and it may be linked to the severity of PD in our patients, which was not specified in the report by Nó brega et al. 2 Finally, another important issue to discuss may be the duration of effectiveness of treatment with BTX-A in Parkinsonian-related sialorrhea. Some patients treated with BTX-A develop secondary immune resistance or do not obtain effective control of symptoms. Therefore, given the efficacy and safety of botulinum toxin type B (BTX-B) also in the management of sialorrhea in PD, 8 we propose switching therapy from BTX-A to BTX-B in patients who are nonresponders or poor responders to BTX-A. 10
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