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

Abstract

scleral search coil technique 4 ; I suspect that it would have shown a torsional component and that this patient also had jerk-waveform see-saw nystagmus.Jerk-waveform see-saw nystagmus occurs with unilateral mesodiencephalic lesions, presumed due to selective unilateral inactivation of the torsional eye velocity integrator in the interstitial nucleus of Cajal 2 ; during the fast (jerk) phases the upper poles of both eyes rotate toward the side of the lesion. With lateral medullary injury the fast phases of the torsional component jerk away from the side of the lesion. 5 In both situations the torsional component is always conjugate. With mesodiencephalic lesions the vertical component is always disjunctive, but with medullary lesions it may be either conjugate (usually upward) or disjunctive. PATRICK LAVIN

Clinical use of botulinum toxins in oral and maxillofacial surgery

“…In therapeutic applications, complications were mostly local and relatively mild, such as pain, erythema, ecchymosis of the region injected, dry eyes, mouth droop, ptosis and lid edema, facial muscle weakness, asymmetry of facial expression during dynamic facial movements, xerostomia, transient dysphagia, restricted mouth opening, nasal regurgitation and nasal speech, headache, blurred vision, dizziness, upset stomach, infection, neck weakness, voice changes, difficulties in chewing and breathing risk of aspiration, recurrent jaw dislocation, dysarthria, salivary duct calculi and local injuries of the carotid arteries or branches of the facial nerve 14,18,[24][25][26]44,45,61,65,79,94,98,129,153,155,157,159,162,207,214,228,232 . Systemic side effects are rarely reported, generally not dose related, and can include transient weakness, fatigue, nausea and pruritis 14 .…”

Amyotrophic lateral sclerosis and palliative care: Where we are, and the road ahead

“…54 For patients who do not respond to anticholinergic agents or who have unacceptable side effects, some data support the use of botulinum toxin injected into the parotid and submandibular glands for patients with ALS and other conditions, such as Parkinson disease. 43,[55][56][57] Although earlier studies have raised concerns about possible side effects, including worsening of dysphagia and chewing difficulties, 58,59 no significant adverse effects were reported in more recent studies, 43 in which injections were done under electromyographic guidance.…”

Expanding use of botulinum toxin

“…However, BTX-A was associated with recurrent jaw dislocation in one patient with ALS [41]. Another study reported marked deterioration of dysphagia and local infection of the gland when the toxin was injected transductally in ALS patients [26]. Most other studies have used ultrasound guidance to direct injections into the parotid and/or submandibular glands.…”