anon saliva.xlsx

Introduction People with severe acquired brain injuries (ABI) can develop sialorrhea (drooling). Salivary gland botulinum neurotoxin (SG-BoNT) injections can reduce saliva production, but there is limited evidence for SG-BoNT in severe ABI. We aimed to determine the effectiveness, impact on chest infection frequency, and safety of SG-BoNT. Materials/Methods Retrospective cohort study of 49 patients, in a specialist ABI care facility, with sialorrhea who received SG-BoNT. Outcome measures included pre- and post-injection Drooling Severity and Frequency Scale (DSFS) scores, pre- and post-injection chest infection frequency, and adverse events. Results 49 patients received 79 SG-BoNT treatments (100 to 200 units of botulinum toxin A). Post-treatment the whole group showed significantly reduced mean DSFS scores (z=-6.4, P<.00001) and significantly fewer chest infections (z=-3.15, p=.0016). Sub-group analysis revealed the reduction in chest infection frequency required repeated treatments (2 or more) and/or higher SG-BoNT doses. There were no adverse events. Conclusions Although there is limited evidence for the use of SG-BoNT in the treatment of sialorrhea for people with ABI, this approach appears to be clinically effective with no detectable adverse effects in this cohort. The reduction in frequency of chest infections following SG-BoNT following repeated injections is an important novel finding.