| Objective:Drooling is one kind of non-motor symptoms in Parkinson’s disease(PD),which severely affects the life quality of patients.Recent studies find out the injection of botulinum toxin type A into the parotid glands and submandibular glands can effectively improve drooling symptoms.This method has been recommended by the Movement Disorder Society.Most of clinical studies abroad on botulinum toxin A for the treatment of drooling in Parkinson’s disease used Onabotulinumtoxin A.However,its price is very high,which restricts its clinical use.Chinese botulinurn toxin type A(CBTX-A)has absolute advantange in price,which can ease the financial burden of patients.This study focused on the safety and therapeutic effect of the injection of Chinese botulinum toxin type A into the parotid glands and submandibular glands for the treatment of drooling in PD,providing drooling PD patients in our country with an economic、safe、effective treatment.Method:This study recruited 8 PD patients from the out-patient department of Neurology in the first affiliated hospital of Dalian Medical University between December 2015 and January 2017.All of these patients had severe drooling symptoms and agreed to receive the treatment of CBTX-A injection.Among them,5 patients received bilateral subthalamic nucleus deep brain stimulation(DBS)at least one year before this study.The conditions of these 5 patients were stable and the stimulating parameters didn’t get altered during the study.All patients underwent ultrasound examination and preliminary localization of their bilateral parotid glands and submandibular glands.Before the injection,we used the sixth item of the II part of Unified Parkinson’s Disease Rating Scale(UPDRS Ⅱ-6)、Drooling Severity and Frequency Scale(DSFS)、Drooling Rating Scale(DRS)、Sialorrhea Clinical Scale for PD(SCS-PD)to assess the drooling symptoms of these patients.Besides,we used swab method to measure the amount of saliva in an given period of time(3 minutes).All the assessments were carried out during the medication "off’period.We informed patients of possible risks and complications of the treatment and signed the "Agreement on special treatment".Based on the drooling severity,we injected 50-100 U CBTX-A into different sites of bilateral parotid glands and submandibular glands.We used URDRS Ⅱ-6、DSFS、DRS and SCS-PD to reassess the drooling symptoms 1 week、1 month、3 months、6 months after the CBTX-A injection treatment.All the assessment、were carried out during the medication "off’period.We followed up with the latency、duration and adverse effects after the injection of CBTX-A.The measurement data were presented as mean±standard deviation.We used paired t test for analysis.If the P<0.05,we considered the differences were statistically significant.Results:1.Using paired t test to compare UPDRS Ⅱ-6、DSFS、DRS、SCS-PD scores and Swab D before the treatment and 1 week、1 month、3 months after the treatment,we found P values were less than 0.05.The differences were statistically significant.2.Using paired t test to compare(UPDRS Ⅱ-6、DSFS、DRS、SCS-PD scores and Swab D before the treatment and 6 months after the treatment,we found the P values were more than 0.05.The difference had no statistical significance.3.Using paired t test to compare UPDRS Ⅱ-6、DSFS、DRS、SCS-PD scores and Swab D 1 week after the treatment and 1 month after the treatment,we found t values were positive and P values were less than 0.05.The differences were statistically significant.4.Using paired t test to compare UPDRS Ⅱ-6、DSFS、DRS、SCS-PD scores and Swab D 1 month after the treatment and 3 months after the treatment,we found t values were negative and P values were less than 0.05.The differences were statistically significant.5.The average latency of CBTX-A effect in the 8 recruited patients was 8.25±3.01 days,and the average duration was 4.56±1.37 months.6.The 8 PD patients experienced no adverse effect during the 6 months follow-up after the treatment.Only one patient had thick saliva 7 days after the treatment.In the next follow-up after 20 days,the symptom got relieved.Conclusions:1.The injection of Chinese botulinum toxin type A into the parotid glands and submandibular glands of PD patients can effectively improve the drooling symptom.The therapeutic effect is significant at 1 month after the injection and decreases after 3 months.2.The treatment of Chinese botulinum toxin type A injection for PD drooling is safe.There is no obvious adverse effect.3.The injection of botulinum toxin type A is an effective method to treat drooling PD patients after deep brain stimulation. |
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