Application of botulinum toxin to treat sialorrhea in amyotrophic lateral sclerosis patients: a literature review

Abstract

Amyotrophic lateral sclerosis is a progressive and fatal neurodegenerative disease characterized by the degeneration of motor neurons, which are the central nervous system cells that control voluntary muscle movements. The excessive salivation (sialorrhea) is present in approximately 50% of amyotrophic lateral sclerosis cases. Thus, some alternative therapeutic methods are sought, such as anticholinergic drugs and surgery. Recently the use of botulinum toxin applied at a midpoint of the salivary glands, often guided by ultrasound, have demonstrated positive results. The objective was to review the literature to demonstrate an alternative method to treatments of sialorrhea in patients with amyotrophic lateral sclerosis. In recent studies, the efficacy of botulinum toxin is confirmed, although new applications are required. Since the side effects are negligible, this is an alternative to treat amyotrophic lateral sclerosis, and other patients with diseases that present sialorrhea.

Clinical and Laryngotracheoscopic Evaluation of Children with Cerebral Palsy Using Intraparotid Injections of Botulinum Toxin Type A for Drooling Control

“…in the submandibular, when applied [9]. In the study, both brands of botulinum toxin available at the hospital were used-Botox®, Dysport®, considering the equivalence of drugs.…”

Toxina botulínica e Odontologia: revisão integrativa

“…O tratamento convencional consiste na utilização de drogas colinérgicas, as quais podem desencadear retenção urinária e cefaleia (Pieh & Gottlob, 2000como citado em Oliveira et al, 2016. Para pacientes com a doença em estágios iniciais, a remoção de uma das glândulas salivares é uma abordagem promissora, porém submete o doente aos riscos anestésicos (Oliveira et al, 2016). A utilização da toxina botulínica nesse quadro é eficiente nas glândulas parótidas e submandibulares, com bons resultados entre o segundo e o terceiro mês de terapêutica (Costa & Ferreira, 2008como citado em Oliveira & Valadão, 2018.…”

Use of Crystallography and Molecular Modeling for the Inhibition of the Botulinum Neurotoxin A Protease

“…Addition of a methyl group in the ortho (8) and meta (9) position produced a ~2-fold increase in potency whereas the para substituted compound 10 exhibited minimal effect on the potency. Of note, addition of an ethyl group (11) in the para position resulted in a ~2-fold loss in potency when compared to unsubstituted benzylamine 7. With the docked structure of 7 (Figure 2D) in mind, this suggested that 11 may be too large, potentially clashing with Phe192 deep within the hydrophobic sub-pocket.…”