Botulinum toxin treatment of secretory disorders

• Published in: Movement disorders 2004-03, Vol.19 (S8), p.S137-S141
• Main Authors: Naumann, Markus, Jost, Wolfgang
• Format: Article
• Language: English
• Subjects: Anti-Dyskinesia Agents - therapeutic use; Axilla - innervation; Biological and medical sciences; botulinum toxin; Botulinum Toxins - therapeutic use; focal hyperhidrosis; Hand - innervation; Humans; Hyperhidrosis - drug therapy; hyperlacrimation; Medical sciences; Neurology; Parkinson Disease - drug therapy; Parkinson's disease; Salivary Gland Diseases - drug therapy; sialorrhea; Sialorrhea - drug therapy
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/mds.20067

Botulinum neurotoxin serotype A (BoNT/A) has revolutionised the treatment of a variety of autonomic hypersecretory disorders. Several open and controlled studies indicate that BoNT/A is a safe and effective treatment for focal hyperhidrosis of the axillae and palms, for gustatory sweating, and for some other rare conditions associated with focal hyperhidrosis. There is class I evidence for the efficacy of botulinum toxin in axillary hyperhidrosis and class II evidence for palmar hyperhidrosis and gustatory sweating. BoNT/A has the potential to replace current invasive and surgical techniques and should at least be considered as a viable alternative. The results of pilot studies to treat sialorrhea are encouraging. However, the optimal dose, best mode of application, side effects, and duration of BoNT/A action in this condition remain uncertain. We need further formal clinical trials to evaluate risks and benefits of BoNT/A for palliative treatment in of sialorrhea in Parkinson's disease and in bulbar amyotrophic lateral sclerosis. Based on the few reports published, BoNT/A injections into the lacrimal gland for hyperlacrimation may be an elegant method to treat this sometimes disabling condition. Again, larger studies are needed to evaluate the risks and long‐term benefits of this treatment option. © 2004 Movement Disorder Society