2025 American Academy of Neurology Abstract Website

Objective:

Botulinum toxin has been an effective and safe treatment option for sialorrhea. This is a report of a successful treatment of sialorrhea with DaxibotulinumtoxinA

Background:

Botulinum neurotoxin (BoNT) has become first line pharmacotherapy for sialorrhea due to high rate of efficacy, and favorable side effect profile. Currently, IncobotulinumtoxinA (USA and Europe) and RimabotulinumtoxinB (USA) are approved for this indication. DaxibotulinumtoxinA is of great interest due to its formulation containing a proprietary 35-amino acid cell-penetrating peptide which may be involved in prolonged duration of clinical benefit.

Design/Methods:

This is a case of a 70 year old with Parkinson’s Disease and silent aspiration due to sialorrhea. Patient was initially injected with RimabotulinumtoxinB, a BoNT formulation approved for sialorrhea. Two cycles of injections 12 weeks apart with escalation of dosing were performed but noted to be only effective for 6-8 weeks.

Patient was initially injected with total of 3000 units of RimabotulinumtoxinB in Parotid glands (1000 units each) and Submandibular glands (500 units each). Subsequently, the dosing was increased to total of 5000 units in Parotid glands (2000 units each) and Submandibular glands (500 units each).

DaxibotulinumtoxinA was subsequently tried. Patient was given 180 units in Parotid glands (60 units each) and Submandibular glands (30 units each). Unit conversion was extrapolated from previous successful reports of neurotoxin conversion.

3 surveys were performed on day of injection, at 4 weeks, and at 13 weeks. Radboud Oral Motor Inventory for Parkinson’s Disease (ROMP), Sialorrhea Clinical Scale for PD (SCS-PD), and Drooling Severity and Frequency Scale (DSFS) were performed.

All surveys revealed improvement of sialorrhea with week 13 results suggestive of sustained efficacy.

Results:

ROMP

3/5/2024=67

4/2/2024=38

6/4/2024=50

SCS-PD

3/5/2024=10

4/2/2024=2

6/4/2024=7

DSFS

3/5/2024=6

4/2/2024=2

6/4/2024=4

Conclusions:

All surveys suggest DaxibotulinumtoxinA provided sustained improvement of sialorrhea and may provide a novel alternative option for those refractory to other treatments.