| Primary Condition | Parkinson’s disease |
| Presenting Complaint | Sialorrhea / excessive drooling |
| Referral Source | Neurologist recommendation for F-ESWT |
| Prior Treatment | Botox injections – no longer eligible for another cycle |
| Treatment | Focused ESWT on salivary glands, 2x/week for 2 weeks |
| Outcome | Drooling resolved; currently on maintenance ESWT |
| Co-Management | Ongoing coordination with neurologist |
Presenting Complaint
This 74-year-old male with Parkinson’s disease was referred by his neurologist for sialorrhea (excessive drooling) after Botox injections stopped working and he was not yet eligible for another cycle. The constant drooling had profound effects on his quality of life—causing embarrassment in public, social withdrawal, and diminished confidence in everyday interactions.
Treatment Approach
Focused shockwave therapy (F-ESWT) was applied directly to the salivary glands (parotid and submandibular). The treatment protocol consisted of 2 sessions per week over 2 weeks, for a total of 4 sessions. There is a growing body of research supporting F-ESWT as an effective non-invasive intervention for sialorrhea in Parkinson’s patients.
Recovery Timeline
| Months 1–12 (Pre-Treatment) | Managed excessive drooling with Botox injections to the salivary glands under neurologist supervision. Provided temporary relief but was no longer eligible for another treatment cycle. Needed an alternative approach to control sialorrhea. |
| ▸ Treatment at City Integrative Rehabilitation | |
| Session 1 | Patient was cautiously optimistic but uncertain about changes. |
| Session 2 | Significant improvement reported—the inflection point where drooling notably decreased. |
| Sessions 3 & 4 | Drooling had effectively stopped. Patient noticed sustained improvement. |
| Ongoing | Improvement maintained for approximately 1 month; now on periodic maintenance ESWT co-managed with neurologist. |
Outcome
Drooling resolved completely after the 4-session treatment course. The improvement held for approximately one month, with the patient describing the result as life-changing. He has returned to socializing and going out in public with confidence and dignity restored.
Why This Case Matters
F-ESWT applications extend far beyond musculoskeletal conditions. Sialorrhea has traditionally been managed with anticholinergic medications or Botox injections, both with limitations. F-ESWT offers a non-invasive alternative that can provide sustained relief. We are proud to co-manage cases like this one with neurologists, demonstrating the interdisciplinary potential of focused shockwave therapy in treating complex neurological symptoms.
This case study is presented for educational purposes and does not constitute medical advice. Individual results may vary. Consult with a qualified healthcare provider to determine if focused shockwave therapy is appropriate for your condition.