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BoNT clinical trial update: Sialorrhea. Toxicon 2023; 226:107087. [PMID: 36931440 DOI: 10.1016/j.toxicon.2023.107087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023]
Abstract
Sialorrhea is the excessive accumulation of saliva, a prevalent symptom among a number of neurologic conditions in both pediatric and adult patients. Over the years, the management of sialorrhea has evolved and included a variety of interventions, ranging from nonpharmacologic, pharmacologic, and surgical treatment options. The most common option for treatment has been the use of botulinum toxin injections in the management of sialorrhea. While there have been several clinical trials to assess the efficacy of botulinum toxin in the treatment of sialorrhea, the largest randomized control trials to date have been with incobotulinumtoxin (2019) and rimabotulinumtoxin (2020) which show consistent reduction in salivary flow rate and improvement in clinical outcomes with comparable duration of treatment effectiveness. In this update, we review the evolution of treatment and injection methods for sialorrhea among many neurologic diseases. We discuss the challenges in evaluating and measuring efficacy in clinical trials for sialorrhea and compare the contemporary botulinum toxin clinical trials in the treatment of sialorrhea.
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Auffret M, Meuric V, Boyer E, Bonnaure-Mallet M, Vérin M. Oral Health Disorders in Parkinson's Disease: More than Meets the Eye. JOURNAL OF PARKINSONS DISEASE 2021; 11:1507-1535. [PMID: 34250950 PMCID: PMC8609694 DOI: 10.3233/jpd-212605] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite clinical evidence of poor oral health and hygiene in Parkinson’s disease (PD) patients, the mouth is often overlooked by both patients and the medical community, who generally focus on motor or psychiatric disorders considered more burdensome. Yet, oral health is in a two-way relationship with overall health—a weakened status triggering a decline in the quality of life. Here, we aim at giving a comprehensive overview of oral health disorders in PD, while identifying their etiologies and consequences. The physical (abnormal posture, muscle tone, tremor, and dyskinesia), behavioral (cognitive and neuropsychiatric disorders), and iatrogenic patterns associated with PD have an overall detrimental effect on patients’ oral health, putting them at risk for other disorders (infections, aspiration, pain, malnutrition), reducing their quality of life and increasing their isolation (anxiety, depression, communication issues). Interdisciplinary cooperation for prevention, management and follow-up strategies need to be implemented at an early stage to maintain and improve patients’ overall comfort and condition. Recommendations for practice, including (non-)pharmacological management strategies are discussed, with an emphasis on the neurologists’ role. Of interest, the oral cavity may become a valuable tool for diagnosis and prognosis in the near future (biomarkers). This overlooked but critical issue requires further attention and interdisciplinary research.
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Affiliation(s)
- Manon Auffret
- Behavior & Basal Ganglia Research Unit (EA 4712), University of Rennes 1, Rennes, France.,Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France
| | - Vincent Meuric
- INSERM, INRAE, Université de Rennes 1, CHU de Rennes, Nutrition Metabolisms and Cancer, Rennes, France
| | - Emile Boyer
- INSERM, INRAE, Université de Rennes 1, CHU de Rennes, Nutrition Metabolisms and Cancer, Rennes, France
| | - Martine Bonnaure-Mallet
- INSERM, INRAE, Université de Rennes 1, CHU de Rennes, Nutrition Metabolisms and Cancer, Rennes, France
| | - Marc Vérin
- Behavior & Basal Ganglia Research Unit (EA 4712), University of Rennes 1, Rennes, France.,Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France.,Movement Disorders Unit, Neurology Department, Pontchaillou University Hospital, Rennes, France
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Niemann N, Billnitzer A, Jankovic J. Parkinson's disease and skin. Parkinsonism Relat Disord 2020; 82:61-76. [PMID: 33248395 DOI: 10.1016/j.parkreldis.2020.11.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/18/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022]
Abstract
Parkinson's disease is associated with a variety of dermatologic disorders and the study of skin may provide insights into pathophysiological mechanisms underlying this common neurodegenerative disorder. Skin disorders in patients with Parkinson's disease can be divided into two major groups: 1) non-iatrogenic disorders, including melanoma, seborrheic dermatitis, sweating disorders, bullous pemphigoid, and rosacea, and 2) iatrogenic disorders related either to systemic side effects of antiparkinsonian medications or to the delivery system of antiparkinsonian therapy, including primarily carbidopa/levodopa, rotigotine and other dopamine agonists, amantadine, catechol-O-methyl transferase inhibitors, subcutaneous apomorphine, levodopa/carbidopa intestinal gel, and deep brain stimulation. Recent advances in our understanding of the role of α-synuclein in peripheral tissues, including the skin, and research based on induced pluripotent stem cells derived from skin fibroblasts have made skin an important target for the study of Parkinson's disease pathogenesis, drug discovery, novel stem cell therapies, and diagnostics.
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Affiliation(s)
- Nicki Niemann
- Muhammad Ali Parkinson Center, Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA.
| | - Andrew Billnitzer
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Laffleur F, Michalek M. Modified xanthan gum for buccal delivery-A promising approach in treating sialorrhea. Int J Biol Macromol 2017; 102:1250-1256. [PMID: 28487193 DOI: 10.1016/j.ijbiomac.2017.04.123] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 10/19/2022]
Abstract
AIM The aim of this study was to modify xanthan, a well-known gelling agent, in order to treat sialorrhea, which increases salivary flow due to an excessive stimulus of the salivary reflex. METHODS Chemical modification occurs by covalent attachment of l-cysteine (SH) to the polymeric backbone of xanthan (X) via amide bond formation. Safety considerations, water uptake capacity, and erosion were evaluated. Furthermore, mucoadhesiveness on buccal mucosa and vapor uptake studies were performed. In vitro/in vivo correlation of reduce of salivary flow was conducted and drug release of embedded tannin was determined. RESULTS Safety investigations ensured modified X-SH being safe to use. X-SH exposed 1.5-x higher water uptake capacity in comparison to unmodified xanthan. Then, stability of X-SH augmented 5.5-fold in the case of matrix erosion studies. Reduction of salivary flow could be obtained 1.6-fold improved in case of X-SH compared to X. Furthermore, tannin was 1.8-fold controlled released in comparison to unmodified xanthan. CONCLUSION Taking these findings into consideration, chemical modified xanthan emerged with its distinctive properties as a promising approach in treating sialorrhea.
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Affiliation(s)
- Flavia Laffleur
- Department of Pharmaceutical Technology, Institute of Pharmacy, Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innrain 80/82, 6020, Innsbruck, Austria.
| | - Martina Michalek
- Department of Pharmaceutical Technology, Institute of Pharmacy, Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innrain 80/82, 6020, Innsbruck, Austria
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Oliveira JB, Evêncio-Neto J, Baratella-Evêncio L. Histological and immunohistochemical findings of the action of botulinum toxin in salivary gland: systematic review. BRAZ J BIOL 2017; 77:251-259. [PMID: 27599097 DOI: 10.1590/1519-6984.11115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 02/15/2016] [Indexed: 11/21/2022] Open
Abstract
The treatment of sialorrhea is necessary for the constant risks posed by hypersalivation. A new therapeutic option comes up with the application of botulinum toxin in salivary glands. However, little is known about its mechanism of action in glandular tissue. Based on the above, this work had the objective to systematically review the literature about the action of botulinum toxin on submandibular and parotid salivary glands tissues. Electronic search was performed in databases of great relevance for this study (PubMed, SciELO, HighWire, Crossref, Scopus, Science Direct, MEDLINE, OLDMEDLINE, Serials Database, NLM Catalog, LILACS and IBECS). Inclusion and exclusion criteria for articles were established, and a total number of 14 articles were selected and used. There are few publications that clarify how the salivary gland acini behave with application of botulinum toxin. Although, the immunohistochemical findings were consistent among authors, showing weak immunoreactivity in glands treated with botulinum toxin. Histometric data are divergent, requiring more detailed studies to answer the questions about the efficacy and safety of botulinum toxin in salivary glands.
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Affiliation(s)
- J B Oliveira
- Department of Anatomy, Biological Sciences Center - CCB, Universidade Federal de Pernambuco - UFPE, Av. Prof. Moraes Rego, 1235, Cidade Universitária, CEP 50670-901, Recife, PE, Brazil
- Post-graduate Program in Bioscience Animal - PPGBA, Universidade Federal Rural de Pernambuco - UFRPE, Rua Dom Manoel de Medeiros, s/n, Dois Irmãos, CEP 52171-900, Recife, PE, Brazil
| | - J Evêncio-Neto
- Post-graduate Program in Bioscience Animal - PPGBA, Universidade Federal Rural de Pernambuco - UFRPE, Rua Dom Manoel de Medeiros, s/n, Dois Irmãos, CEP 52171-900, Recife, PE, Brazil
- Department of Animal Morphology and Physiology, Universidade Federal Rural de Pernambuco - UFRPE, Rua Dom Manoel de Medeiros, s/n, Dois Irmãos, CEP 52171-900, Recife, PE, Brazil
| | - L Baratella-Evêncio
- Department of Histology and Embryology, Biological Sciences Center - CCB, Universidade Federal de Pernambuco - UFPE, Av. Prof. Moraes Rego, 1235, Cidade Universitária, CEP 50670-901, Recife, PE, Brazil
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Dysphagia in Parkinson’s Disease. Dysphagia 2017. [DOI: 10.1007/174_2017_118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Botulinum Toxin Therapy for Nonmotor Aspects of Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1111-1142. [DOI: 10.1016/bs.irn.2017.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Skorvanek M, Bhatia KP. The Skin and Parkinson's Disease: Review of Clinical, Diagnostic, and Therapeutic Issues. Mov Disord Clin Pract 2017; 4:21-31. [PMID: 30363435 PMCID: PMC6174479 DOI: 10.1002/mdc3.12425] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) and the skin are related in a number of ways, including clinical abnormalities of the disease itself and skin-related side effects of dopaminergic medication, pumps, and surgical therapies. Recent advances in understanding the role of α-synuclein suggest skin biopsies as a potential diagnostic or even a premotor marker of PD. METHODS The PubMed database was searched for publications up to October 2015, and the current evidence on skin-related issues in PD was comprehensively summarized. RESULTS The evidence was summarized on the prevalence, etiology, and management of seborrheic dermatitis, sweating dysfunctions, bullous pemphigoid, and malignant melanoma, as well as therapy-related skin disorders, especially those observed in amantadine, rotigotine, apomorphine, and levodopa/carbidopa intestinal gel therapies and deep-brain stimulation. Skin biopsies evaluating the presence of α-synuclein, the density and morphology of cutaneous nerves, and skin fibroblast functions also are discussed. CONCLUSIONS Skin disorders are a common manifestation of PD. However, the exact pathophysiology and prevalence of these disorders are not well understood, and more systematic research is needed in this regard. Peripheral tissue biopsies as a diagnostic marker of PD are an exciting avenue in future PD research, although multiple caveats and pending issues need to be solved before they can be used in routine clinical practice.
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Affiliation(s)
- Matej Skorvanek
- Department of NeurologyP. J. Safarik UniversityKosiceSlovakia
- Department of NeurologyUniversity Hospital L. PasteurKosiceSlovakia
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement DisordersUCL Institute of NeurologyUniversity College LondonLondonUnited Kingdom
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Hill F, Miller N, Walsh RA, Mockler D, McDowell R, Walshe M. Botulinum toxin for drooling in Parkinson’s disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Fiona Hill
- Tallaght Hospital; Department of Speech & Language Therapy; Tallaght Dublin 24 Ireland
| | - Nick Miller
- Newcastle University; Institute of Health and Society; Newcastle upon Tyne UK NE1 4LP
| | - Richard A Walsh
- Tallaght Hospital; Department of Neurology; Tallaght Dublin 24 Ireland
| | - David Mockler
- Trinity Centre for Health Sciences, St. James Hospital; John Stearne Library; St James's Hospital Dublin 8 Dublin Ireland
| | - Ronald McDowell
- Royal College of Surgeons; Department of General Practice; Dublin 2 Ireland
| | - Margaret Walshe
- Trinity College Dublin; Clinical Speech and Language Studies; 7-9 South Leinster Street Dublin Ireland 2
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Ou R, Guo X, Wei Q, Cao B, Yang J, Song W, Chen K, Zhao B, Chen X, Shang H. Diurnal drooling in Chinese patients with Parkinson's disease. J Neurol Sci 2015; 353:74-8. [PMID: 25896289 DOI: 10.1016/j.jns.2015.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/05/2015] [Accepted: 04/06/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study is to explore the prevalence and clinical correlates of diurnal drooling in Chinese patients with Parkinson's disease (PD). METHODS A cross-sectional analysis of 518 Chinese patients with PD was conducted. Each subject was categorized as a diurnal "drooler" or a "non-drooler" using the Non-Motor Symptoms Scale (NMSS). RESULTS One hundred and twenty-one (23.4%) patients exhibited diurnal drooling. Diurnal drooling was reported more frequently in male and late-onset PD patients (p<0.05). The levodopa equivalent daily doses, mean age and disease duration, the percentages of PD family history and levodopa or entacapone use, the incidences of dysarthria, dysphagia and fluctuation, and the Unified PD Rating Scale (UPDRS) part III, NMSS, Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) and PD Questionnaire 39 (PDQ-39) scores in droolers were significantly greater than in non-droolers (p<0.05). The percentage of benzhexol use in non-droolers was significantly higher than in droolers (p<0.05). The Frontal assessment battery (FAB) and Montreal Cognitive Assessment (MoCA) scores were not different between the droolers and non-droolers. The forward binary logistic regression model indicated that dysarthria, male sex, age, UPDRS part III, sexual dysfunction and a family history of PD were associated with diurnal drooling. CONCLUSIONS Diurnal drooling is a relatively common debilitating symptom in Chinese PD patients. It is not only related to male sex, age, dysarthria and PD family history, but also correlates with motor and non-motor severity especially sexual dysfunction of PD. However, it is not related to cognition.
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Affiliation(s)
- Ruwei Ou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoyan Guo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qianqian Wei
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bei Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Song
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ke Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bi Zhao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xueping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Drooling in Parkinson's disease: a review. Parkinsonism Relat Disord 2014; 20:1109-18. [PMID: 25200111 DOI: 10.1016/j.parkreldis.2014.08.013] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/14/2014] [Accepted: 08/17/2014] [Indexed: 12/13/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease causing both motor and non-motor symptoms. Drooling, an excessive pooling and spillover of saliva out of the oral cavity, is one of the non-motor symptoms in PD patients that produces various negative physical and psychosocial consequences for patients and their caregivers. At present, the pathophysiology of drooling in PD is not completely certain; however, impaired intra-oral salivary clearance is likely the major contributor. There are neither standard diagnostic criteria nor standard severity assessment tools for evaluating drooling in PD. In accordance with the possible pathophysiology, dopaminergic agents have been used to improve salivary clearance; however, these agents are not completely effective in controlling drooling. Various pharmacological and non-pharmacological treatment options have been studied. Local injection with botulinum toxin serotypes A and B into major salivary glands is most effective to reduce drooling. Future research to explore the exact pathophysiology and develop standard diagnostic criteria and standard severity assessment tools are needed to formulate specific treatment options and improve patient care.
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Gerszt PP, Baltar CR, Santos AED, Oda AL. Interferência do tratamento medicamentoso imediato e tardio na doença de Parkinson no gerenciamento da disfagia. REVISTA CEFAC 2014. [DOI: 10.1590/1982-02162014141-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A Doença de Parkinson apresenta grande incidência na população idosa, gerando comprometimento motor progressivo, que afeta várias funções, dentre as quais se destaca a deglutição. Esse trabalho teve como objetivo relacionar a disfagia na Doença de Parkinson aos efeitos imediatos e/ou tardios do tratamento medicamentoso, que de forma direta ou indireta interferirá no gerenciamento fonoaudiológico. Fizemos uma revisão de literatura nas bases de dados eletrônicas Lilacs, Scielo, Medline e Pubmed no período de 2001 a 2011, utilizando os termos livres “Doença de Parkinson”; (Parkinson Disease), “deglutição”; (deglutition), “disfagia”; (dysphagia), “preparações farmacêuticas”; (pharmaceutical preparations), “levodopa”;, “videofluoroscopia”; (videofluoroscopy), além de um documento governamental (OPAS, 2002), artigos relevantes e exemplares da literatura americana e brasileira sobre o tema. A literatura aponta a Levodopa como o principal tratamento farmacológico da doença de Parkinson. Contudo, a melhora dos sintomas motores deve ser ponderada em função da ocorrência de efeitos colaterais importantes, sejam imediatos ou tardios. Até o momento não há respostas consistentes a favor da melhora da disfagia como resultado do tratamento farmacológico, cujos efeitos podem interferir direta ou indiretamente sobre as manifestações disfágicas e de várias formas. Assim, torna-se fundamental o registro das medicações como parte da anamnese, considerando que tais dados possam auxiliar na orientação/reorientação da conduta fonoaudiológica, especialmente em contexto interdisciplinar. A despeito da possibilidade do doente de Parkinson responder de forma inconsistente à terapia farmacológica, vale ressaltar que o profissional deve estar atento à presença de efeitos colaterais como fatores modificadores do quadro de disfagia orofaríngea na Doença de Parkinson idiopática.
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Rana AQ, Khondker S, Kabir A, Owalia A, Khondker S, Emre M. Impact of cognitive dysfunction on drooling in Parkinson's disease. Eur Neurol 2013; 70:42-5. [PMID: 23711510 DOI: 10.1159/000348571] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 01/13/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is commonly characterized by its motor symptoms such as resting tremor, rigidity, bradykinesia and postural instability; however, some of the most debilitating symptoms of this disease are non-motor ones such as dementia and sialorrhea (drooling). Drooling is caused by impaired swallowing and it can have a significant impact on the quality of life. However, it is still unclear whether cognitive dysfunction could exacerbate drooling. We wanted to examine if any relationship existed between drooling and dementia in PD patients. Identifying the correlation will aid physicians to screen and initiate early management of drooling in the course of PD. This can possibly lead to improvements in the quality of life in these patients. METHODS In this retrospective study, we investigated the prevalence of drooling in 314 PD patients and further compared the difference in the prevalence of drooling in patients with dementia and without dementia. In addition, we studied the impact of gender on drooling in this patient population. RESULTS Our results show that a significant correlation exists between drooling and dementia in our sample of PD patients. Furthermore, in males, the correlation between the prevalence of drooling and dementia was found to be clinically significant as compared to the female population. CONCLUSION Our findings suggest that drooling is a major concern in the course of PD and should therefore be addressed early and more aggressively in patients with dementia.
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Affiliation(s)
- Abdul Qayyum Rana
- Parkinson's Clinic of Eastern Toronto, Scarborough, Ont., Canada. ranaaq @ yahoo.com
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Kasarskis EJ, Hodskins J, Clair WHS. Unilateral parotid electron beam radiotherapy as palliative treatment for sialorrhea in amyotrophic lateral sclerosis. J Neurol Sci 2011; 308:155-7. [DOI: 10.1016/j.jns.2011.06.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 06/02/2011] [Accepted: 06/07/2011] [Indexed: 12/11/2022]
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Diurnal and nocturnal drooling in Parkinson's disease. J Neurol 2011; 259:119-23. [PMID: 21698387 PMCID: PMC3251785 DOI: 10.1007/s00415-011-6138-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 05/29/2011] [Accepted: 06/06/2011] [Indexed: 12/16/2022]
Abstract
Drooling as symptom of Parkinson's disease (PD) has thus far been poorly defined. This uncertainty is reflected by high variations in published prevalence rates. The aim of this study was to investigate the prevalence of saliva loss versus accumulation of saliva as a possible preliminary stage, and diurnal drooling versus nocturnal drooling. In addition, we evaluated the association between drooling severity and the severity of facial and oral motor disorders. We collected age, disease duration, UPDRS III and Hoehn & Yahr stage from 104 consecutive outpatients with PD. Diurnal and nocturnal drooling was evaluated with a validated questionnaire (ROMP-saliva). A speech pathologist, blinded for drooling severity, rated facial expression, involuntary mouth opening and difficulty with nose breathing and also interviewed patients about sleeping position and nose-breathing during the night. Thirty patients (29%) had no complaints with saliva control ('non-droolers'), 45 patients (43%) experienced accumulation of saliva or only nocturnal drooling ('pre-droolers'), and 29 (28%) had diurnal drooling (24 of which also drooled during the night; 'droolers'). The droolers had longer disease duration (10 vs. 7 years, p = 0.01) and drooling was independently associated with involuntary mouth opening (OR = 2.0; 95% CI 1.02-3.99) and swallowing complaints (OR = 1.2; 95% CI 1.03-1.31). Diurnal drooling-defined as dribbling of saliva while awake-is present in about 28% of PD patients. This is less than usually reported. Diurnal drooling typically appeared later in the disease course. The association with oral motor behavior should encourage the development of behavioral treatment approaches.
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Clinical management of microstomia due to the static treatment of facial paralysis and oral rehabilitation with dental implants. J Craniofac Surg 2011; 22:967-9. [PMID: 21558911 DOI: 10.1097/scs.0b013e31820fe2f5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Facial-nerve paralysis is seldom seen and may occur because of a broad spectrum of causes. The most commonly seen cause of facial paralysis is the Bell palsy; iatrogenic causes and tumors are relatively rare. Facial asymmetry, drooling, garbled speech, and difficulty in feeding: all adversely affect the psychosocial conditions of the patients. Fascial and tendon sling procedures may be performed for the static treatment of the unilateral permanent facial paralysis. These techniques are used both for the correction of the asymmetry of the face, especially by providing static support for the corner of the mouth, and to prevent drooling. Microstomia after a sling procedure is not a previously observed complication in the literature. A patient is presented with the surgical management of the complication of microstomia that had risen because of a static treatment of his unilateral facial paralysis via a tendon that passes circularly through his orbicularis oris muscle. Oral rehabilitation thereafter was maintained with the support of dental implants and fixed prosthodontics. The most efficient treatment protocol was decided with an interdisciplinary consultation of the oral and maxillofacial surgeon, the plastic surgeon, and the prosthodontist.
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