Introduction:
Sialorrhea is a common disabling symptom in ALS at times resistant to routine therapies. Treatment with botulinum toxin type B (BoNT-B) injection has shown benefit.
Objective:
To review benefits, side effects, and barriers to treatment of BoNT-B in the treatment of sialorrhea in patients with ALS.
Methods:
A retrospective chart review was performed. Detailed clinical information was recorded including response to treatment using patient reported analog scale ranging from 1 (no sialorrhea) to 9 (max sialorrhea) and mean daily tissue use, duration of benefit, side effects, drop out, and time to insurance approval. A paired t-test was used for analysis.
Results:
Twelve patients were treated from 10/2015 – 2/2019. Eleven had previously tried 1-2 other agents. Eight patients received 2 or more injections (range 1 – 7). Pre and post treatment outcome data was available for 7 patients. All reported improvement with mean decline of 4 points (p = 0.001). Mean daily tissue decline was 57% (range 0-100%). The benefit lasted on average of 8.3 weeks (range 6-10). Three reported side effects of dry mouth and increased saliva thickness, with no progression of bulbar weakness related to treatment. Seven patients stopped treatment, 4 due to death, 3 due to declining health, and none due to side effects. Five patients had private insurance, and rest with Medicare. Median time to approval was 1 day (range 1 – 14) with no insurance denials.
Summary/Conclusions:
BoNT-B treatment of sialorrhea in patients with ALS is safe and effective with minimal barriers to treatment.