BRIEF RESEARCH REPORT article
Front. Neurol.
Sec. Neurorehabilitation
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1639242
This article is part of the Research TopicRehabilitation of Mechanically Ventilated and Tracheostomized PatientsView all 6 articles
The use of Botulinum Toxin Type A in Patients in Out-of-Hospital Intensive Care in Germany – Results from a Multidisciplinary Online Survey
Provisionally accepted
Martin Groß1,2,3*
Victoria Ohla3- 1MEDIAN Klinik Bad Tennstedt, Bad Tennstedt, Germany
- 2Carl von Ossietzky Universitat Oldenburg, Oldenburg, Germany
- 3Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung und Intensivversorgung (DIGAB) e.V., Göttigen, Germany
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Introduction In Germany, approximately 23.000 patients live in of out-of-hospital intensive care settings. About 80% suƯer from neurological diseases and are prone to spasticity and sialorrhea, which again can be eƯectively treated with Botulinum Toxin Type A (BoNT-A). This study investigates the utilization, barriers, and training needs associated with BoNT-A application. Methods An online questionnaire with ten questions was developed by the German Interdisciplinary Society for Out-of-Hospital Ventilation and Intensive Care (DIGAB) and distributed via the mailing lists of the DIGAB, the German Society for Respiratory Therapy, and the nursing supervisors of the Deutsche Fachpflege, and to speech-and-language therapists via a private mailing list. Results The survey was sent to 702 healthcare professionals, with 41 participants completing the survey. Only 160 (20%) of 789 patients with spasticity and 111 (14%) of 816 patients with sialorrhea or salivary aspiration received BoNT-A treatment. Barriers included unavailability of trained providers, logistical challenges, and uncertainty regarding cost coverage. Participants emphasized the importance of staƯ training, availability of medical specialists and treatment in the home environment. Conclusion Despite its potential to facilitate care, improve quality of life, and to promote participation in out-of-hospital intensive care, BoNT-A remains underused. Education on multidisciplinary treatment of spasticity and sialorrhea, improved reimbursement for BoNT-A administration, expansion of the role of the neurologist by adapting the regulatory framework, and integration of BoNT-A in treatment guidelines are required. Further research should collect individual-level data on spasticity, dystonia, sialorrhea, and BoNT-A treatment, and examine healthcare delivery across diƯerent healthcare structures.
Keywords: Botulinum toxin type A, Out-of-Hospital Intensive Care, Spasticity, Sialorrhea, Hypersalivation, aspiration
Received: 02 Jun 2025; Accepted: 22 Sep 2025.
Copyright: © 2025 Groß and Ohla. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Martin Groß, martin.gross@gmx.at
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.