Therapie der Sialorrhoe mit Botulinumtoxin – ein
                    Update

Wolfgang H. Jost; Tobias Bäumer; Steffen Berweck; Rainer Laskawi; Björn Spittau; Armin Steffen; Martin Winterholler

doi:10.1055/a-1802-3867

Fortschritte der Neurologie · Psychiatrie, Table of Contents

Fortschr Neurol Psychiatr 2022; 90(05): 222-232
DOI: 10.1055/a-1802-3867

Übersichtsarbeit

Therapie der Sialorrhoe mit Botulinumtoxin – ein Update

Therapy of Sialorrhea with Botulinum Toxin – An Update

Wolfgang H. Jost

¹Parkinson-Klinik Ortenau, Wolfach, Germany

,

Tobias Bäumer

²Institut für Systemische Motorikforschung, CBBM, Sektion Zentrum für Seltene Erkrankungen, UKSH, Universität zu Lübeck, Lübeck, Germany

,

Steffen Berweck

³Schön Klinik Vogtareuth, Vogtareuth, Germany

⁴Dr von Haunersches Kinderspital Kinderklinik und Kinderpoliklinik der Ludwig Maximilian Universitat München, München, Germany

,

Rainer Laskawi

⁵Georg-August-Universitat Göttingen HNO-Klinik, Göttingen, Germany

,

Björn Spittau

⁶Anatomie und Zellbiologie, Medizinische Fakultät OWL, Universität Bielefeld, Bielefeld, Germany

,

Armin Steffen

⁷Universitätsklinikum Schleswig-Holstein Campus Lübeck HNO Klinik, Lübeck, Germany

,

Martin Winterholler

⁸Krankenhaus Rummelsberg gGmbH, Schwarzenbruck, Germany

› Author Affiliations

Abstract

Zusammenfassung

Die größten Speicheldrüsen sind die paarigen Gl. parotis und Gl. submandibularis. Der erwachsene Mensch produziert 1–1,5 l Speichel am Tag, die er regelmäßig abschluckt. Die häuﬁgste Ursache eines vermehrten Speichelﬂusses mit einer Ansammlung von Speichel im Mund und Ausﬂuss (Sialorrhoe) ist eine Störung der Schluckfunktion. Seltener kann auch eine vermehrte Speichelsekretion, z. B. medikamentös bedingt, die Ursache sein. Eine Sialorrhoe beeinträchtigt die Lebensqualität erheblich und ist oft auch sozial stigmatisierend. Die Therapie umfasst konservative Maßnahmen wie die funktionelle Dysphagietherapie, orale oder transdermale Applikation von Anticholinergika sowie, in ausgewählten Fällen, invasive Therapien wie Bestrahlungen und Operationen. Seit 20 Jahren wird auch die lokale Injektion von Botulinumtoxin in die Speicheldrüsen erfolgreich therapeutisch eingesetzt. Durch die Zulassung von IncobotulinumtoxinA für die Behandlung von Kindern und Erwachsenen darf diese Maßnahme als Therapie der Wahl bei chronischer Sialorrhoe angesehen werden. Die Ergebnisse der Zulassungsstudien zeigen bei Kindern wie auch Erwachsenen eine hohe Effektivität und gute Verträglichkeit der Injektionsbehandlung.

Abstract

The most important salivary glands are the paired parotid and submandibular glands. Adults produce 1 to 1.5 liters of saliva which are then regularly swallowed. When the act of swallowing is disturbed, salivation occurs. More rarely, the cause can be found in increased saliva production, for example, when caused through medication. Sialorrhea impairs the quality of life substantially and is frequently often socially stigmatizing. Therapy includes conservative measures such as functional dysphagia therapy, oral or transdermal application of anticholinergics, as well as, in selected cases, radiation and surgical measures. Over the last 20 years, local injection of botulinum toxin has been successfully applied in the treatment of this condition. With approval of incobotulinumtoxinA toxin for children and adults, this procedure will become the therapy of choice for chronic sialorrhea. The results of the phase III registration trials have demonstrated high efficacy and good safety of the injection treatment in both children and adults.

Schlüsselwörter

Sialorrhoe - Dysphagie - Anticholinergika - Botulinumtoxin

Key words

sialorrhea - dysphagia - anticholinergics - botulinum toxin

Full Text

References

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