You can’t underestimate the social embarrassment and hygienic issues associated with sialorrhea, or uncontrolled drooling.

The condition, however, is now highly treatable — and without the side effects seen with more traditional treatment.

Treating sialorrhea with injectable botulinum toxins is not something that all neurologists know about, according to Dr. Laxman Bahroo, a neurologist at Georgetown University Hospital.

“I think one of the most important messages about sialorrhea is to understand that it is treatable with a simple procedure which can provide significant benefit to patients,” Bahroo told us recently.

Uncontrolled drooling is a common side effect for patients suffering from Parkinson’s disease, amyotrophic lateral sclerosis (ALS), stroke and other neurological conditions. It can have a great impact on mental and physical health.

Excessive drooling can result in social withdrawal as well as chapped skin, tooth decay, sleep troubles and even aspiration pneumonia. Both patients and their caregivers express frustration about these effects, Bahroo said.

How Botox Changes the Game

Traditionally, the first line of treatment has been the use of oral medications like Glycopyrrolate and other anticholinergics. But, these treatment options come with significant side effects like confusion, dry eyes, slow heart rate, and worsening balance.

That is why Bahroo uses botulinum toxin (botox) injections for sialorrhea treatment – namely incobotulinumtoxinA (brand name Xeomin) and rimabotulinumtoxinB (brand name Myobloc).

According to a 2020 study published in JAMA Neurology, Myobloc is effective in reducing symptoms as soon as one week after injection. Patients responded well to treatment and enjoyed positive effects for 13 weeks, according to the study.

The introduction of botox injections in treating sialorrhea has totally changed Bahroo’s practice and he is eager to spread the word. He encourages his colleagues to learn more about these newer treatments and discuss them with their patients.

Of the many issues that impact the lives of Parkinson’s patients and those with other neurodegenerative diseases, sialorrhea is now amongst the more manageable ones,” he said.

Special thanks to Laxman Bahroo, MD, FAAN, Director of Botulinum Toxin Clinic and Associate Professor of Neurology at MedStar Georgetown University Hospital.