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Ban MJ, Ryu CH, Woo JH, Lee YC, Lee DK, Kwon M, Hong YT, Lee GJ, Byeon HK, Choi SH, Lee SW. Guidelines for the Use of Botulinum Toxin in Otolaryngology From the Korean Society of Laryngology, Phoniatrics and Logopedics Guideline Task Force. Clin Exp Otorhinolaryngol 2023; 16:291-307. [PMID: 37905325 DOI: 10.21053/ceo.2023.00458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/25/2023] [Indexed: 11/02/2023] Open
Abstract
The Korean Society of Laryngology, Phoniatrics and Logopedics created a task force to establish clinical practice guidelines for the use of botulinum toxin (BT) in otolaryngology. We selected 10 disease categories: spasmodic dysphonia, essential vocal tremor, vocal fold granuloma, bilateral vocal fold paralysis, Frey's syndrome, sialocele, sialorrhea, cricopharyngeal dysfunction, chronic sialadenitis, and first bite syndrome. To retrieve all relevant papers, we searched the CORE databases with predefined search strategies, including Medline (PubMed), Embase, the Cochrane Library, and KoreaMed. The committee reported 13 final recommendations with detailed evidence profiles. The guidelines are primarily aimed at all clinicians applying BT to the head and neck area. In addition, the guidelines aim to promote an improved understanding of the safe and effective use of BT by policymakers and counselors, as well as in patients scheduled to receive BT injections.
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Affiliation(s)
- Myung Jin Ban
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Joo Hyun Woo
- Department of Otorhinolaryngology-Head and Neck Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Dong Kun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Tae Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Gil Joon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyung Kwon Byeon
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Won Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Harbottle J, Carlin H, Payne-Doris T, Tedd HMI, de Soyza A, Messer B. Developing an intrasalivary gland botox service for patients receiving long-term non-invasive ventilation at home: a single-centre experience. BMJ Open Respir Res 2022; 9:9/1/e001188. [PMID: 35190461 PMCID: PMC8862502 DOI: 10.1136/bmjresp-2021-001188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 01/31/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Sialorrhoea is a debilitating symptom in neurological disease and there is a growing literature for the use of intrasalivary gland Botulinum Toxin (botox) injections in its management. However, provision of intrasalivary gland botox remains inconsistent and sialorrhoea is often poorly controlled in motor neuron disease (MND). Sialorrhoea in association with bulbar dysfunction can cause intolerance of non-invasive ventilation (NIV) and respiratory infection, so its treatment is critical within a home ventilation service (HVS). This treatment can also be used to enable tracheostomy cuff deflation to facilitate weaning from ventilation. We report on the outcomes of intrasalivary gland botox in our HVS. Methods In 2015, we set up an intrasalivary gland botox service for patients under our HVS. Under ultrasound guidance, we injected submandibular gland (SMG), parotid gland (PG) or both. Results 109 intrasalivary gland botox procedures were performed in 72 patients. Diagnostic groups included MND 32 Cerebral Palsy 8 and Weaning 14. Glands injected were, SMG (6%), PG (47%) and both (47%). The majority (84%) received the Dysport preparation with mean dose 273 units. 94% were ultrasound guided. 81% of injections resulted in a positive treatment effect, with 47% patients requesting repeat injections. Complications were angioedema (0.9%) and worsening dysphagia (3.7% following SMG injection). Mean survival following treatment was 40 months with 53% patients still alive. Conclusions Intrasalivary gland botox appears effective across a range of neurological conditions requiring long-term NIV with few complications. Dysphagia may be an important complication of SMG injection. A randomised controlled trial may help establish the evidence base.
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Affiliation(s)
- Jessica Harbottle
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Hannah Carlin
- Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Thomas Payne-Doris
- North East Assisted Ventilation Service, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Hilary M I Tedd
- Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Anthony de Soyza
- Population Health Science Institutes, Newcastle University, Newcastle upon Tyne, UK
| | - Ben Messer
- North East Assisted Ventilation Service, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
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3
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Mantelakis A, Spencer H, Duval JL, Joshi A. Botulinum Toxin in the Management of Hyperhidrosis and Other Salivary Conditions. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00304-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Singh H, Nene Y, Mehta TR, Govindarajan R. Efficacy of Botulinum Toxin for Treating Sialorrhea in Neuromuscular Conditions. Front Neurol 2020; 11:513. [PMID: 32587569 PMCID: PMC7297943 DOI: 10.3389/fneur.2020.00513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/08/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Drooling related to bulbar weakness and dysfunction is a common concern in patients with neuromuscular disease. While there are numerous medications to manage sialorrhea, they are often limited by side effects and lack of efficacy. Botulinum toxin has shown to benefit ALS patients in a few studies, but there is scant data on the benefit in other neuromuscular conditions. Objective: To assess the effectiveness of Botulinum toxin in reducing sialorrhea in patients with various neuromuscular disease. Design/Methods: 25 patients (19M, 6F; 54.36 ± 17.09 yr) with documented neuromuscular illness and concern for drooling was followed for 6 weeks after Botulinum toxin injection. These patients had one of the following diagnoses: Duchenne muscular dystrophy (3), myotonic dystrophy (3), oculopharyngeal muscular dystrophy (1), inclusion body myositis (2), primary lateral sclerosis (1), amyotrophic lateral sclerosis (9), spinal muscular atrophy type 2 and 3 (2), spinal-bulbar muscular atrophy (2), and Becker's muscular dystrophy (2). A subjective drooling scale (1: markedly worse, 5: markedly better) and drooling thickness score (0=normal, 100=thick) was calculated on these patients prior to the injection and 4 and 6 weeks after the injection. Botulinum toxin 20-30 units were injected into bilateral parotid gland (70% of the dose) and submandibular gland (30% of the dose). Results: The drooling thickness score at before the injection was 75.2 ± 10.46. At 4 and 6 weeks, average scores reduced to 47.2 ± 6.14 and 18.8 ± 5.26, respectively (p < 0.05). The average pre injection perception about drooling was 3.0 (p < 0.05). The average change in perception was +0.84 and +1.28 at 4 and 6 weeks, respectively, (p < 0.05) implying significant improvement. There were no reported adverse effects. Conclusion: This study provides preliminary evidence for the use of botulinum toxin for refractory sialorrhea for a variety of neuromuscular conditions.
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Affiliation(s)
- Harsh Singh
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - Yash Nene
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - Tejas R Mehta
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - Raghav Govindarajan
- Assistant Professor of Neurology, Department of Neurology, University of Missouri, Columbia, MO, United States
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5
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Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal disease with no cure; however, symptomatic management has an impact on quality of life and survival. Symptom management is best performed in a multidisciplinary care setting, where patients are evaluated by multiple health care professionals. Respiratory failure is a significant cause of morbidity and mortality in patients with ALS. Early initiation of noninvasive ventilation can prolong survival, and adequate use of airway clearance techniques can prevent respiratory infections. Preventing and treating weight loss caused by dysphagia may slow down disease progression, and expert management of spasticity from upper motor neuron dysfunction enhances patient well-being.
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Affiliation(s)
- Jonathan R Brent
- Department of Neurology, Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Chicago, IL 60611, USA
| | - Colin K Franz
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Neurology, Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John M Coleman
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Senda Ajroud-Driss
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Marvulli R, Megna M, Citraro A, Vacca E, Napolitano M, Gallo G, Fiore P, Ianieri G. Botulinum Toxin Type A and Physiotherapy in Spasticity of the Lower Limbs Due to Amyotrophic Lateral Sclerosis. Toxins (Basel) 2019; 11:E381. [PMID: 31266172 PMCID: PMC6669765 DOI: 10.3390/toxins11070381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 12/31/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease (unknown pathogenesis) of the central nervous system that causes death within 1-5 years. Clinically, flabby paralysis, areflexia, muscular atrophy, and muscle fasciculations, signs of II motor neuron damage, appear. Sometimes, clinical manifestations of damage of the I motor neuron come out in lower limbs; spastic paralysis, iperflexia, and clonus emerge, and they impair deambulation and management of activities of daily living, such as personal hygiene or dressing. Thus, the first therapeutic approach in these patients involves antispasmodic drugs orally followed by botulinum toxin type A injection (BTX-A). In this study, we study the efficacy of BTX-A and physiotherapy in lower limb spasticity due to ALS and no response to treatment with oral antispastic drugs. We evaluated 15 patients (10 male and five female), with a mean age of 48.06 ± 5.2 with spasticity of adductor magnus (AM), at baseline (T0, before BTX-A treatment) and in the following three follow-up visits (T1 30 days, T2 60 days, and T3 90 days after infiltration). We evaluated myometric measure of muscle tone, the Modified Ashworth Scale of AM, Barthel Index, Adductor Tone Rating Scale, and Hygiene Score. The study was conducted between November 2018 and April 2019. We treated AM with incobotulinum toxin type A (Xeomin®, Merz). Spasticity (myometric measurement, Adductor Tone Rating Scale, and Modified Ashworth Scale) and clinical (Barthel Index and Hygiene Score) improvements were obtained for 90 days after injection (p < 0.05). Our study shows the possibility of using BTX-A in the treatment of spasticity in patients with ALS and no response to oral antispastic drugs, with no side effects. The limitation of the study is the small number of patients and the limited time of observation; therefore, it is important to increase both the number of patients and the observation time in future studies.
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Affiliation(s)
- Riccardo Marvulli
- Department of Basic Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", G. Cesare Place 11, 70125 Bari, Italy.
| | - Marisa Megna
- Department of Basic Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", G. Cesare Place 11, 70125 Bari, Italy
| | - Aurora Citraro
- Department of Basic Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", G. Cesare Place 11, 70125 Bari, Italy
| | - Ester Vacca
- Department of Basic Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", G. Cesare Place 11, 70125 Bari, Italy
| | - Marina Napolitano
- Department of Basic Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", G. Cesare Place 11, 70125 Bari, Italy
| | - Giulia Gallo
- Department of Basic Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", G. Cesare Place 11, 70125 Bari, Italy
| | - Pietro Fiore
- Department of Basic Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", G. Cesare Place 11, 70125 Bari, Italy
| | - Giancarlo Ianieri
- Department of Basic Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", G. Cesare Place 11, 70125 Bari, Italy
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Steffen A, Jost W, Bäumer T, Beutner D, Degenkolb-Weyers S, Groß M, Grosheva M, Hakim S, Kahl KG, Laskawi R, Lencer R, Löhler J, Meyners T, Rohrbach-Volland S, Schönweiler R, Schröder SC, Schröder S, Schröter-Morasch H, Schuster M, Steinlechner S, Urban R, Guntinas-Lichius O. Hypersalivation: update of the German S2k guideline (AWMF) in short form. J Neural Transm (Vienna) 2019; 126:853-862. [DOI: 10.1007/s00702-019-02000-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/27/2019] [Indexed: 12/11/2022]
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Garuti G, Rao F, Ribuffo V, Sansone VA. Sialorrhea in patients with ALS: current treatment options. Degener Neurol Neuromuscul Dis 2019; 9:19-26. [PMID: 31118868 PMCID: PMC6498144 DOI: 10.2147/dnnd.s168353] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder of the motor neuron, which selectively affects it both at central (first motor-neuron) and peripheral level (second motor-neuron). The disease shows up at a mean age of 56 years and the most affected are males. Although ALS may start as a bulbar or spinal disease, with the progression of the disease typically both become evident. Pharmacological approved treatments for ALS are still limited and include riluzole and edaravone which improve survival over time. Despite this, ALS leads to progressive muscle involvement and requires a complex multidisciplinary approach to manage increasing disability which goes beyond motor neurons. Sialorrhea is, amongst others, one of the most disabling symptoms in ALS. The complexity in managing saliva is due to a muscular spasticity and to a scarce palatino-lingual muscles control, rather than to an overproduction of saliva. These features could increase the risk of aspiration pneumonia and limit the use of noninvasive mechanical ventilation. We reviewed the treatment for sialorrhea in ALS patients that are available at this time, emphasizing pros and cons for each approach. Our purpose is to create a practical tool for the diagnosis, in order to facilitate the quantification and management of sialorrhea in everyday practice.
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Affiliation(s)
- Giancarlo Garuti
- Pneumology Unit, Santa Maria Bianca Hospital, Mirandola, AUSL Modena, Modena, Italy
| | - Fabrizio Rao
- Respiratory Unit, Neuromuscular OmniCentre (NeMO), Neurorehabilitation, University of Milan, Niguarda Hospital, Milan, Italy
| | - Viviana Ribuffo
- Pneumology Unit, Santa Maria Bianca Hospital, Mirandola, AUSL Modena, Modena, Italy
| | - Valeria A Sansone
- Neuromuscular Omnicentre (NeMO), Neurorehabilitation, University of Milan, Niguarda Hospital, Milan, Italy
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9
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Ribeiro LB, Xerez DR, Maliska C, Souza SAL, Costa MMB. Qualitative and quantitative scintigraphy in sialorrhea before and after botulinum toxin injection. Laryngoscope 2019; 129:2521-2526. [DOI: 10.1002/lary.27826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/20/2018] [Accepted: 12/31/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Livia Barroso Ribeiro
- Serviço de Medicina Física e ReabilitaçãoHospital Universitário Clementino Fraga FilhoUniversidade Federal do Rio de Janeiro Rio de Janeiro Brazil
| | - Denise Rodrigues Xerez
- Serviço de Medicina Física e ReabilitaçãoHospital Universitário Clementino Fraga FilhoUniversidade Federal do Rio de Janeiro Rio de Janeiro Brazil
| | - Carmelindo Maliska
- Departamento de RadiologiaFaculdade de MedicinaUniversidade Federal do Rio de Janeiro Rio de Janeiro Brazil
| | - Sergio Augusto Lopes Souza
- Departamento de RadiologiaFaculdade de MedicinaUniversidade Federal do Rio de Janeiro Rio de Janeiro Brazil
| | - Milton Melciades Barbosa Costa
- Instituto de Ciências Biomédicas, Laboratório de Motilidade Digestiva e ImagemUniversidade Federal do Rio de Janeiro Rio de Janeiro Brazil
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10
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Mulkerrin S, Edwards V, Roberts R. Management of people with swallowing difficulties in late-stage neurodegenerative disease. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/npre.2018.16.4.176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Síofra Mulkerrin
- Speech and language therapist, Addenbrooke's Hospital, Cambridge
| | - Victoria Edwards
- Speech and language therapist, Addenbrooke's Hospital, Cambridge
| | - Rhys Roberts
- Consultant neurologist, Addenbrooke's Hospital, Cambridge
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11
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Abstract
Neuromuscular diseases are syndromic disorders that affect nerve, muscle, and/or neuromuscular junction. Knowledge about the management of these diseases is required for anesthesiologists, because these may frequently be encountered in the intensive care unit, operating room, and other settings. The challenges and advances in management for some of the neuromuscular diseases most commonly encountered in the operating room and neurointensive care unit are reviewed.
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Affiliation(s)
- Veronica Crespo
- Department of Anesthesiology, Duke University, Erwin Road, Durham, NC 27710, USA
| | - Michael L Luke James
- Department of Anesthesiology, Duke University, Erwin Road, Durham, NC 27710, USA; Department of Neurology, Duke University, Erwin Road, Durham, NC 27710, USA.
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12
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McGeachan AJ, Hobson EV, Al-Chalabi A, Stephenson J, Chandran S, Crawley F, Dick D, Donaghy C, Ellis CM, Gorrie G, Hanemann CO, Harrower T, Jung A, Malaspina A, Morrison KE, Orrell RW, Talbot K, Turner MR, Williams TL, Young CA, Shaw PJ, McDermott CJ. A multicentre evaluation of oropharyngeal secretion management practices in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2016; 18:1-9. [PMID: 27579520 DOI: 10.1080/21678421.2016.1221433] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Failure to clear oral secretions can be debilitating for patients with amyotrophic lateral sclerosis (ALS), but the treatment of this symptom is poorly defined and there is no consensus on best practice. The objective of this study was to identify the treatments that are commonly prescribed, and to describe how experienced clinicians manage a patient with treatment resistant symptoms. Twenty-three clinicians were approached, of which 19 from 16 centres across the UK provided case report forms for a total of 119 ALS patients identified as having problematic oral secretions. The use of five anticholinergics, salivary gland botulinum toxin injections, conservative management approaches and carbocisteine were reported. Of the 72 patients who were evaluated following the initiation of a first anticholinergic, 61% had symptomatic improvement. Only 19% of patients achieved symptomatic improvement with the use of an alternative anticholinergic when an initial anticholinergic achieved no symptomatic improvement. Problems with thick and thin secretions often coexisted, with 37% of patients receiving treatment for both types of problem. In conclusion, a variety of treatment options are employed by expert clinicians for problematic oral secretions in ALS patients. The variation in management highlights the need for further prospective research in this area.
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Affiliation(s)
- Alexander J McGeachan
- a Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, & Academic Directorate of Neurosciences, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield
| | - Esther V Hobson
- a Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, & Academic Directorate of Neurosciences, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield
| | - Ammar Al-Chalabi
- b King's College London, Institute of Psychiatry , Department of Clinical Neuroscience , London
| | - Jodie Stephenson
- a Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, & Academic Directorate of Neurosciences, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield
| | | | - Francesca Crawley
- d Department of Neurology , West Suffolk NHS Foundation Trust , Bury St. Edmunds
| | - David Dick
- e Department of Neurology , Norfolk and Norwich University Hospital , Norwich
| | - Colette Donaghy
- f Department of Neurology , Royal Victoria Hospital , Belfast
| | - Cathy M Ellis
- g Motor Neuron Disease Care and Research Centre , Kings College Hospital , London
| | - George Gorrie
- h Institute of Neurological Sciences, Southern General Hospital , Glasgow
| | - C Oliver Hanemann
- i Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry , Plymouth
| | - Timothy Harrower
- j Department of Neurology , Royal Devon and Exeter Foundation Trust Hospital
| | - Agam Jung
- k Department of Neurology , Leeds General Infirmary , Leeds
| | - Andrea Malaspina
- l Centre for Neuroscience and Trauma , Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, & Department of Neurology, Basildon University Hospital , Basildon
| | - Karen E Morrison
- m Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, and Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust , Birmingham
| | - Richard W Orrell
- n Department of Clinical Neuroscience , University College London Institute of Neurology, London, & MND Care and Research Centre, National Hospital for Neurology and Neurosurgery , Queen Square , London
| | - Kevin Talbot
- o Oxford University Nuffield Department of Clinical Neurosciences , John Radcliffe Hospital , Oxford
| | - Martin R Turner
- o Oxford University Nuffield Department of Clinical Neurosciences , John Radcliffe Hospital , Oxford
| | - Timothy L Williams
- p Department of Neurology , Royal Victoria Infirmary , Newcastle-upon-Tyne , and
| | - Carolyn A Young
- q The Walton Centre for Neurology and Neurosurgery , Liverpool , UK
| | - Pamela J Shaw
- a Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, & Academic Directorate of Neurosciences, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield
| | - Christopher J McDermott
- a Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, & Academic Directorate of Neurosciences, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield
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13
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Matsuda C, Shimizu T, Nakayama Y, Haraguchi M, Mochizuki Y, Hakuta C, Taira M, Numayama T, Kinoshita M. Analysis of resting salivation rate in patients with amyotrophic lateral sclerosis using tracheostomy invasive ventilation. Rinsho Shinkeigaku 2016; 56:465-71. [PMID: 27356730 DOI: 10.5692/clinicalneurol.cn-000849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patients with amyotrophic lateral sclerosis (ALS) often suffer from salivation problems such as drooling and dry mouth. We examined resting salivation rate cross-sectionally in 66 advanced ALS patients with tracheostomy invasive ventilation using a cotton roll method, and investigated clinical factors associated with salivation rate. Resting salivation rate in the patients was well preserved (median value 0.6 g/min), and was significantly more increased in patients with impairment of jaw movement (P = 0.007) or mouth opening (P = 0.003) than in patients with less impairment, and in patients with the mouth being constantly open ≥ 10 mm in rostrocaudal length than in patients with < 10 mm. These data indicate that salivation rate was increased with progression of dysfunction of voluntary jaw movement. Appropriate oral care is required in advanced ALS patients to maintain their oral hygiene and to avoid penetration of saliva into the airway.
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Affiliation(s)
- Chiharu Matsuda
- ALS Nursing Care Project, Tokyo Metropolitan Institute of Medical Science
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14
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Mazlan M, Rajasegaran S, Engkasan JP, Nawawi O, Goh KJ, Freddy SJ. A Double-Blind Randomized Controlled Trial Investigating the Most Efficacious Dose of Botulinum Toxin-A for Sialorrhea Treatment in Asian Adults with Neurological Diseases. Toxins (Basel) 2015; 7:3758-70. [PMID: 26402703 PMCID: PMC4591664 DOI: 10.3390/toxins7093758] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/09/2015] [Accepted: 09/10/2015] [Indexed: 12/14/2022] Open
Abstract
This study aims to determine the most efficacious dose of Botulinum neurotoxin type A (BoNT-A) in reducing sialorrhea in Asian adults with neurological diseases. A prospective, double-blind randomized controlled trial was conducted over 24 weeks. Thirty patients with significant sialorrhea were randomly assigned to receive a BoNT-A (Dysport®) injection into the submandibular and the parotid glands bilaterally via an ultrasound guidance. The total dose given per patient was either BoNT-A injection of (i) 50 U; (ii) 100 U; or (iii) 200 U. The primary outcome was the amount of saliva reduction, measured by the differential weight (wet versus dry) of intraoral dental gauze at baseline and at 2, 6, 12, and 24 weeks after injection. The secondary outcome was the subjective report of drooling using the Drooling Frequency and Severity Scale (DFS). Saliva reduction was observed in response to all BoNT-A doses in 17 patients who completed the assessments. Although no statistically significant difference among the doses was found, the measured reduction was greater in groups that received higher doses (100 U and 200 U). The group receiving 200 U of Dysport® showed the greatest reduction of saliva until 24 weeks and reported the most significant improvement in the DFS score.
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Affiliation(s)
- Mazlina Mazlan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, 12th Floor, Menara Selatan, University Malaya Medical Centre, Jalan Universiti, 59100 Kuala Lumpur, Malaysia.
| | - Shivani Rajasegaran
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, 12th Floor, Menara Selatan, University Malaya Medical Centre, Jalan Universiti, 59100 Kuala Lumpur, Malaysia.
| | - Julia Patrick Engkasan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, 12th Floor, Menara Selatan, University Malaya Medical Centre, Jalan Universiti, 59100 Kuala Lumpur, Malaysia.
| | - Ouzreiah Nawawi
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 12th Floor, Menara Selatan, University Malaya Medical Centre, Jalan Universiti, 59100 Kuala Lumpur, Malaysia.
| | - Khean-Jin Goh
- Neurology Division, Department of Medicine, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603 Kuala Lumpur, Malaysia.
| | - Saini Jeffery Freddy
- KPJ KL Rehabilitation Centre, Tawakkal Health Centre, 202A, Jalan Pahang, 53000 Kuala Lumpur, Malaysia.
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15
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Karam CY, Paganoni S, Joyce N, Carter GT, Bedlack R. Palliative Care Issues in Amyotrophic Lateral Sclerosis: An Evidenced-Based Review. Am J Hosp Palliat Care 2014; 33:84-92. [PMID: 25202033 DOI: 10.1177/1049909114548719] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
As palliative care physicians become increasingly involved in the care of patients with amyotrophic lateral sclerosis (ALS), they will be asked to provide guidance regarding the use of supplements, diet, exercise, and other common preventive medicine interventions. Moreover, palliative care physicians have a crucial role assisting patients with ALS in addressing health care decisions to maximize quality of life and cope with a rapidly disabling disease. It is therefore important for palliative care physicians to be familiar with commonly encountered palliative care issues in ALS. This article provides an evidenced-based review of palliative care options not usually addressed in national and international ALS guidelines.
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Affiliation(s)
- Chafic Y Karam
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sabrina Paganoni
- Harvard Medical School, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, and Boston VA Healthcare System
| | - Nanette Joyce
- Department of Physical Medicine and Rehabilitation, Neuromuscular Section, University of California, Davis Medical School, Sacramento, CA, USA
| | - Gregory T Carter
- Department of Physical Medicine and Rehabilitation St Luke's Rehabilitation Institute, Spokane, WA, USA
| | - Richard Bedlack
- Duke University School of Medicine, and Durham Veterans Affairs Medical Center, Durham, NC, USA
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