ORIGINAL RESEARCH article
Front. Neurol.
Sec. Movement Disorders
Effects of focal low energy extracorporeal shock wave treatment (ESWT) on reduction of sialorrhea in Parkinson's disease
Provisionally accepted
- 1Neurology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- 2Neurology Unit, Hospital Care Department of Medicine, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
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Introduction: Sialorrhea is a frequent and disabling non-motor symptom in Parkinson's disease (PD) and atypical parkinsonian syndromes, often exerting a serious impact on patients' health and quality of life (QoL). Botulinum toxin injections into the major salivary glands, which reduce salivary secretion, represent an established and effective therapy. However, even with adequate operator training and ultrasound guidance, transient dysphagia may occur. Low-energy extracorporeal shock wave therapy (ESWT) is a noninvasive neuromodulatory technique that has shown anticholinergic-like and antispastic effects in neurological disorders. Aims: To evaluate the effects of low-energy ESWT applied to the salivary glands as a potential treatment for sialorrhea in patients with PD or atypical parkinsonian syndromes. Methods: In this pilot observational study, 12 patients with advanced PD or atypical parkinsonism and clinically significant sialorrhea (UPDRS-II item 2 ≥ 2) underwent two weekly sessions of bilateral focal ESWT (750 impulses per gland, 0.1–0.3 mJ/mm², 5 Hz) under ultrasound guidance. Clinical assessments were performed at baseline and at 1st, 4th, 8th, and 12th week post-treatment using the Drooling Frequency and Severity Scale (DSFS, primary endpoint), Nocturnal Hypersalivation Rating Scale (NHRS), Sialorrhea Clinical Scale for PD (SCS-PD), Drooling Impact Score (DIS), and both Clinical and Patient Global Impression of Change (CGI-C, PGI-C). Results: A statistically significant improvement was observed across all scales at week 4 post-treatment, with more sustained effects on DSFS and SCS-PD. Improvements were evident as early as week 1 and persisted up to week 8 for SCS-PD. DIS scores significantly decreased from baseline to week 4 (p=0.005). Subjective improvement was reported by 75% of patients (PGI-C) and confirmed by clinicians in 83.3% (CGI-C). No adverse effects, pain, or dysphagia were reported. Conclusions: Focal low-energy ESWT demonstrated efficacy in reducing sialorrhea in patients with advanced PD and atypical parkinsonism. These preliminary findings suggest a novel, well-tolerated, and noninvasive treatment approach that may improve QoL and serve as a potential alternative or adjunct to botulinum toxin therapy.
Keywords: ESWT, Parkinson's disease, shock wave therapy, Sialorrhea, toxin
Received: 05 Nov 2025; Accepted: 09 Dec 2025.
Copyright: © 2025 Manganotti, Rangan, Catalan and Sartori. 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: Paolo Manganotti
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