Background Sialorrhoea is a common symptom of chronic neurological conditions and can cause significant burdens. Until recently NICE recommended that an anti-muscarinic medication should be considered first for sialorrhoea treatment in Parkinson’s and Motor Neuron Disease. In 2019, NICE suggested that patients would welcome better access to botulinum toxin following the publication of evidence supporting its long-term efficacy and safety. This prompted consideration of our own clinical practice in Wessex.

Methods A questionnaire designed to evaluate professionals’ prescribing practice in the management of sialorrhoea and experience of using botulinum toxin was distributed to Palliative Medicine and Neurology multidisciplinary teams.

Results The questionnaire was completed by 45 Palliative Medicine (64.4%) and Neurology (24.4%) professionals. A variety of drugs were used to treat sialorrhoea; hyoscine hydrobromide (42%), glycopyrronium (22%), atropine (20%), amitriptyline (8%) and propantheline (8%). Professionals were not confident that drugs adequately controlled sialorrhoea, yet botulinum toxin was only utilised in 2% of cases where a drug failed. Perceived barriers to utilising botulinum toxin were identified. These included complexity of saliva management in progressive disease and the burden and complications of treatment. Accessibility, lack of experience and knowledge of its effectiveness were also highlighted.

Conclusions This has emphasised the complexity of sialorrhoea management; pharmacological approaches are varied and professionals are not confident that these interventions are effective. Whilst botulinum toxin is recommended as an alternative option, challenges exist. This highlights the need to develop and promote research into the management options for this symptom. The planned follow-up project is the development of a decision aid, by a multidisciplinary team, to guide lifestyle and behaviour modification; tailoring prescribing and identification of when botulinum toxin referral is appropriate, with evaluation of its impact.