Botulinum toxin A versus B in sialorrhea: A prospective, randomized, double-blind, crossover pilot study in patients with amyotrophic lateral sclerosis or Parkinson's disease

Guidubaldi, Arianna; Fasano, Alfonso; Ialongo, Tàmara; Piano, Carla; Pompili, Maurizio; Mascianà, R.; Siciliani, Luisa; Sabatelli, Mario; Bentivoglio, Anna Rita

doi:10.1002/mds.23473

Cited by 118 publications

(79 citation statements)

References 38 publications

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“…Recovery of function from neuromuscular paralysis by botulinum neurotoxins varies according to the serotype and the target tissue, but for BoNT/A, the duration of action is typically 1 to 3 months (Rossetto et al, 2001). BoNT/B had a shorter duration in some (Sloop et al, 1997;Blitzer, 2005) but not all (Pappert et al, 2008;Guidubaldi et al, 2011) studies, whereas recovery from paralysis by BoNT/E was more rapid (Eleopra et al, 1998). The duration of the functional central nervous system (CNS) actions of these toxins is not known, although in one study cleaved SNAP-25 was evident for a prolonged period after intrahippocampal injection of BoNT/A (Antonucci et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Long-Lasting Attenuation of Amygdala-Kindled Seizures after Convection-Enhanced Delivery of Botulinum Neurotoxins A and B into the Amygdala in Rats

Gąsior

Tang

Rogawski

2013

J Pharmacol Exp Ther

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Botulinum neurotoxins (BoNTs) are well recognized to cause potent, selective, and long-lasting neuroparalytic actions by blocking cholinergic neurotransmission to muscles and glands. There is evidence that BoNT isoforms can also inhibit neurotransmission in the brain. In this study, we examined whether locally delivered BoNT/A and BoNT/B can attenuate kindling measures in amygdala-kindled rats. Male rats were implanted with a combination infusion cannula-stimulating electrode assembly into the right basolateral amygdala. Fully kindled animals received a single infusion of vehicle or BoNT/A or BoNT/B at doses of 1, 3.2, or 10 ng over a 20-minute period by convectionenhanced delivery. Electrographic (EEG) and behavioral kindling measures were determined at selected times during the 3-to 64-day period after the infusion. BoNT/B produced a dose-dependent elevation in after-discharge threshold and duration and a reduction in the seizure stage and duration of behavioral seizures that lasted for up to 50 days after infusion. BoNT/A had similar effects on EEG measures; behavioral seizure measures were also reduced, but the effect did not reach statistical significance. The effects of both toxins on EEG and behavioral measures progressively resolved during the latter half of the observation period. Animals gained weight normally, maintained normal body temperature, and did not show altered behavior. This study demonstrates for the first time that locally delivered BoNTs can produce prolonged inhibition of brain excitability, indicating that they could be useful for the treatment of brain disorders, including epilepsy, that would benefit from long-lasting suppression of neurotransmission within a circumscribed brain region.

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Section: Introductionmentioning

confidence: 99%

Long-Lasting Attenuation of Amygdala-Kindled Seizures after Convection-Enhanced Delivery of Botulinum Neurotoxins A and B into the Amygdala in Rats

Gąsior

Tang

Rogawski

2013

J Pharmacol Exp Ther

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“…Considering that the effect of BTX in the treatment of hypersalivation generally lasts about 2–4 months,19, 20 our finding suggests that duration of BTXA effect in hypersalivation due to anti‐NMDA receptor encephalitis is similar to that due to other neurological disorders. However, despite these results, its duration in anti‐NMDA receptor encephalitis still remains unclear because hypersalivation is significantly affected by disease activity.…”

Section: Discussionmentioning

confidence: 65%

Botulinum toxin treatment for hypersalivation in anti‐NMDA receptor encephalitis

Jun

Seo

Lee

et al. 2017

Ann Clin Transl Neurol

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Hypersalivation is one of the intractable symptoms of anti‐N‐methyl‐d‐aspartate receptor (NMDAR) encephalitis. While anticholinergic medications partially improve the hypersalivation, they can aggravate the autonomic dysfunctions associated with anti‐NMDAR encephalitis. Thus, we investigated the efficacy and safety of botulinum toxin type A injection on hypersalivation refractory to anticholinergics in six patients with anti‐NMDAR encephalitis. Hypersalivation was well‐controlled without remarkable adverse reaction over 16 weeks after botulinum toxin type A, although two patients were reinjected at 12 weeks due to reaggravation of hypersalivation. Our findings suggest that botulinum toxin type A might be a better choice than anticholinergics for management of hypersalivation in patients with anti‐NMDAR encephalitis.

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“…44 BoNT serotypes A and B are considered to be equally efficacious and safe. In a study evaluating the differences between the 2 serotypes, Guidubaldi et al 46 found that BoNT-B has a shorter latency and the same duration of efficacy compared with BoNT-A. However, the costs of the 2 treatments are significantly different: at the doses used in the study, a treatment with BoNT-B costs approximately half that with BoNT-A.…”

Section: Bont (Botox)mentioning

confidence: 99%

A Review of Options for Treating Sialorrhea in Amyotrophic Lateral Sclerosis

et al. 2014

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Sialorrhea or drooling represents quite a common problem in patients with amyotrophic lateral sclerosis (ALS). In this review, we describe the possible treatments for this issue. Current medical management is not always effective: anticholinergic drugs (atropine, glycopyrrolate, amitriptyline, hyoscyamine, and transdermal scopolamine) are often used, but there is very little evidence of their effectiveness in patients with ALS. More invasive treatments, such as botulinum toxin injections and/or radiation therapy in the salivary glands, can be considered when anticholinergic drugs are not effective. In this review, we also explore the possible surgical options for treatment of sialorrhea. Although no specific studies have been conducted on patients with ALS, surgical therapies might represent a valid option for treatment of sialorrhea since there is no tachyphylaxis or need for repeated therapeutic sessions.

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Botulinum toxin A versus B in sialorrhea: A prospective, randomized, double-blind, crossover pilot study in patients with amyotrophic lateral sclerosis or Parkinson's disease

Abstract: Either 250 U Dysport or 2500 U Neurobloc have similar effectiveness and safety in controlling sialorrhea. BoNT-B has a shorter latency and comparable duration. Cost analysis, considering the doses used in this study protocol favored BoNT-B treatment.

Cited by 118 publications

References 38 publications

Long-Lasting Attenuation of Amygdala-Kindled Seizures after Convection-Enhanced Delivery of Botulinum Neurotoxins A and B into the Amygdala in Rats

Long-Lasting Attenuation of Amygdala-Kindled Seizures after Convection-Enhanced Delivery of Botulinum Neurotoxins A and B into the Amygdala in Rats

Botulinum toxin treatment for hypersalivation in anti‐NMDA receptor encephalitis

A Review of Options for Treating Sialorrhea in Amyotrophic Lateral Sclerosis

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