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Orriëns LB, de Groot SAF, van der Burg JJW, van den Hoogen FJA, van Hulst K, Erasmus CE. Interdisciplinary assessment and treatment of paediatric drooling: two decades of experience by the Nijmegen saliva control team reflected in a stepwise algorithm. Eur J Pediatr 2024; 183:3979-3985. [PMID: 38943011 PMCID: PMC11322295 DOI: 10.1007/s00431-024-05658-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 06/30/2024]
Abstract
Anterior and posterior drooling are prevalent comorbidities in children with neurodevelopmental disabilities. Considering the heterogeneity of the patient population and the multifactorial aetiology of drooling, an interdisciplinary and individualised treatment approach is indispensable. However, no tool for stepwise decision-making in the treatment of paediatric drooling has been developed previously. Within the Radboudumc Amalia Children's Hospital, care for children with anterior and/or posterior drooling secondary to neurodevelopmental disabilities is coordinated by a saliva control team with healthcare professionals from six disciplines. In alignment with international literature, published guidelines, and evidence gained from two decades of experience and research by our team, this paper proposes an algorithm reflecting the assessment and treatment approach applied in our clinic. First, directions are provided to decide on the necessity of saliva control treatment, taking type of drooling, the child's age, and the severity and impact of drooling into account. Second, the algorithm offers guidance on the choice between available treatment options, highlighting the importance of accounting for child characteristics and child and caregiver preferences in clinical (shared) decision-making. CONCLUSIONS With this algorithm, we aim to emphasise the importance of repeated stepwise decision-making in the assessment and treatment of drooling in children during their childhood, encouraging healthcare professionals to apply a holistic approach. WHAT IS KNOWN • Children with anterior or posterior drooling secondary to neurodevelopmental disabilities comprise a heterogeneous group, necessitating an individualised treatment approach. • No stepwise decision-making tool is available for the treatment of paediatric drooling. WHAT IS NEW • Deciding on the necessity of saliva control treatment should be a conscious process, based on type of drooling, age, and drooling severity and impact. • Type of drooling, age, cognition, oral motor skills, self-awareness, posture, diagnosis, and child/caregiver preferences need to be considered to decide on the optimal treatment.
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Affiliation(s)
- Lynn B Orriëns
- Department of Paediatric Neurology, Division of Paediatrics, Donders Institute for Brain, Cognition and Behaviour, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands.
| | - Sandra A F de Groot
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jan J W van der Burg
- Department of Paediatric Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
- School of Pedagogical and Educational Science, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Karen van Hulst
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Corrie E Erasmus
- Department of Paediatric Neurology, Division of Paediatrics, Donders Institute for Brain, Cognition and Behaviour, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands
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Gholami Z, Poorjavad M, Nouri R. A Scoping Review on the Effects of Kinesio Taping on Oropharyngeal Function Related to Swallowing and Feeding. Dysphagia 2024:10.1007/s00455-024-10739-6. [PMID: 39096332 DOI: 10.1007/s00455-024-10739-6] [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: 03/02/2024] [Accepted: 07/23/2024] [Indexed: 08/05/2024]
Abstract
Following the expansion of interdisciplinary communication among rehabilitative service providers, new techniques have been introduced for treating swallowing disorders. Kinesio taping (KT) is one of the recently noticed techniques in the rehabilitation of swallowing and feeding disorders. Given the novelty of this technique in research and practice, the present scoping review aimed to summarize the available evidence on the effects of KT on the oropharyngeal function related to swallowing, and to identify current knowledge gaps to guide future studies. The initial comprehensive search was conducted in the six databases in November 2022 and then was updated in June 2023. Studies were independently reviewed by two authors to exclude all types of reviews and study protocols, studies published only in an abstract form and also studies that used KT for improving voice and dysarthria symptoms. The methodology of the included studies was also critically appraised using Joanna Briggs Institute (JBI) standard tools by two authors. The results of the studies were categorized and reported based on their overall objectives. In final analysis, 21 articles were described. Study designs ranged from randomized control trials (RCTs) to the case reports. The effects of KT had been investigated on drooling, oral feeding skills of infants, immediate activation of swallowing muscles, and management of dysphagia in patients with stroke or cerebral palsy (CP). Although innovative approaches to use KT as a therapeutic method in swallowing disorders have been investigated in the studies, there are many methodological limitations that affected validity of the results. In general, it seems there is not enough evidence to add KT to the usual management of feeding and swallowing disorders yet. Further studies, therefore, are required to achieve more accurate conclusions in each of the objectives summarized in this study.
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Affiliation(s)
- Zohreh Gholami
- Speech Therapy Department, Rehabilitation School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marziyeh Poorjavad
- Speech Therapy Department, Rehabilitation School, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Rasool Nouri
- Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Yilmaz N, Turker D, Aytar A, Yemisci OU, Aytar A. The Acute Effects of Kinesio Taping on Drooling in Children with Cerebral Palsy: A Randomized Placebo-Controlled Trial. Dev Neurorehabil 2024; 27:161-168. [PMID: 38967352 DOI: 10.1080/17518423.2024.2374080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 04/29/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION This study purpose of determining the short-term effects of kinesio taping on drooling in children with cerebral palsy (CP). METHODS CP were randomly divided into 3 groups as the kinesio tape (n = 16), sham tape (n = 16), and control (n = 16) groups. The drooling severity and frequency were assessed with the Drooling Severity and Frequency Scale, and the amount of saliva was measured by the 5-minute drooling quotient. All outcome measurements were repeated for all children at the baseline, after 45 minutes, and after 2 days of application. RESULTS There was a significant decrease found in drooling severity, frequency, and amount in the kinesio taping group (p < .05). There was no significant difference in the sham taping and control groups (p > .05). CONCLUSION The use of kinesio tape in drooling reduced drooling severity, frequency, and amount.
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Affiliation(s)
- Nilsah Yilmaz
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Duygu Turker
- Gulhane Faculty of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Ayca Aytar
- Vocational School of Health Sciences, Physiotherapy Program, Baskent University, Ankara, Turkey
| | - Oya Umit Yemisci
- Department of Physical and Rehabilitation Medicine, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Aydan Aytar
- Gulhane Faculty of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
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Elendu C, Jeswani BM, Madekwe CC, Chukwuneta CP, Sidhu AK, Okorie CO, Banerjee AV, Oshin BD. Clinical and electroencephalographic correlates of carbamazepine-associated hiccups in epileptic patients. Ann Med Surg (Lond) 2024; 86:4015-4034. [PMID: 38989169 PMCID: PMC11230812 DOI: 10.1097/ms9.0000000000002159] [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: 03/28/2024] [Accepted: 05/02/2024] [Indexed: 07/12/2024] Open
Abstract
Carbamazepine, a commonly prescribed antiepileptic drug, is known to induce hiccups in a subset of epileptic patients. Although relatively uncommon, can have significant clinical implications. This comprehensive review delves into the clinical and electroencephalographic correlates of carbamazepine-associated hiccups, aiming to enhance understanding and management of this neurological side effect. The authors' review synthesizes qualitative epidemiological data, revealing that carbamazepine-induced hiccups occur in a subset of patients receiving the medication, with reported incidence rates ranging from 2.5 to 40%. Despite its relatively low prevalence, hiccups pose substantial challenges for patients and healthcare providers. Complications associated with carbamazepine-induced hiccups include disruption of sleep, impaired social functioning, and decreased quality of life, underscoring the clinical significance of this side effect. Effective management strategies can be implemented through a multidisciplinary approach, including collaboration among neurologists, pharmacists, and other healthcare professionals. These may include dose adjustments, medication discontinuation, and adjunctive therapies such as diaphragmatic breathing exercises or acupuncture. Additionally, close monitoring for adverse effects and timely intervention are essential to mitigate the impact of hiccups on patient well-being. Essentially, carbamazepine-induced hiccups represent a clinically relevant phenomenon that warrants attention in the management of epilepsy. By recognizing the clinical manifestations, understanding the underlying pathophysiology, and implementing evidence-based management strategies, healthcare providers can optimize patient care and improve outcomes in this patient population.
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Affiliation(s)
| | - Bijay M. Jeswani
- GCS Medical College, Hospital & Research Centre, Ahmedabad, Gujarat, India
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Parrot M, Yathavan B, Averin O, Hoggard L, Rower JE, Voight M, Greene D, Tarrell A, Whelan A, Ghandehari H, Murphy N, Yellepeddi V. Clinical pharmacokinetics of atropine oral gel formulation in healthy volunteers. Clin Transl Sci 2024; 17:e13753. [PMID: 38465519 PMCID: PMC10926053 DOI: 10.1111/cts.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/01/2024] [Accepted: 02/14/2024] [Indexed: 03/12/2024] Open
Abstract
Sialorrhea or drooling is a common problem in children and adults with neurodevelopmental disorders. It can negatively impact the quality of life due to its physical and psychological manifestations. Providers commonly prescribe atropine eye drops for topical administration to the oral mucosa, as an off-label treatment to manage sialorrhea. However, the off-label use of atropine eye drops can be associated with medication and dosing errors and systemic side effects. To address these limitations of treatment, we developed a mucoadhesive topical oral gel formulation of atropine as an alternative route to off-label administration of atropine eye drops. In this clinical pharmacokinetic (PK) study, we evaluated the safety and PK of atropine gel (0.01% w/w) formulation after single-dose administration to the oral mucosa in 10 healthy volunteers. The PK data showed that after topical administration to the oral mucosa, atropine followed a two-compartment PK profile. The maximum plasma concentration and area under the curve extrapolated to infinite time were 0.14 ng/mL and 0.74 h·ng·mL-1 , respectively. The absorption rate constant calculated by the compartmental analysis was 0.4 h-1 . Safety parameters, such as heart rate, blood pressure, and oxygen saturation, did not significantly change before and after administration of the gel formulation, and no adverse events were observed in all participants who received atropine gel. These data indicate that atropine gel formulation has a satisfactory PK profile, is well-tolerated at the dose studied, and can be further considered for clinical development as a drug product to treat sialorrhea.
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Affiliation(s)
- Madison Parrot
- Division of Clinical Pharmacology, Department of Pediatrics, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUtahUSA
- Department of Molecular Pharmaceutics, Utah Center for Nanomedicine, College of PharmacyUniversity of UtahSalt Lake CityUtahUSA
| | - Bhuvanesh Yathavan
- Department of Molecular Pharmaceutics, Utah Center for Nanomedicine, College of PharmacyUniversity of UtahSalt Lake CityUtahUSA
| | - Olga Averin
- Department of Pharmacology and Toxicology and Center for Human ToxicologyUniversity of UtahSalt Lake CityUtahUSA
| | - Logan Hoggard
- Department of Pharmacology and Toxicology and Center for Human ToxicologyUniversity of UtahSalt Lake CityUtahUSA
| | - Joseph E. Rower
- Department of Pharmacology and Toxicology and Center for Human ToxicologyUniversity of UtahSalt Lake CityUtahUSA
| | - Michael Voight
- Investigational Drug Service, Pharmacy Services, University of Utah HospitalSalt Lake CityUtahUSA
| | - Danielle Greene
- Division of Clinical Pharmacology, Department of Pediatrics, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Ariel Tarrell
- Division of Clinical Pharmacology, Department of Pediatrics, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Aviva Whelan
- Division of Clinical Pharmacology, Department of Pediatrics, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Hamidreza Ghandehari
- Department of Molecular Pharmaceutics, Utah Center for Nanomedicine, College of PharmacyUniversity of UtahSalt Lake CityUtahUSA
| | - Nancy Murphy
- Division of Complex Care, Department of PediatricsUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Venkata Yellepeddi
- Division of Clinical Pharmacology, Department of Pediatrics, Spencer Fox Eccles School of MedicineUniversity of UtahSalt Lake CityUtahUSA
- Department of Molecular Pharmaceutics, Utah Center for Nanomedicine, College of PharmacyUniversity of UtahSalt Lake CityUtahUSA
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Canfora F, Calabria E, Spagnuolo G, Coppola N, Armogida NG, Mazzaccara C, Solari D, D’Aniello L, Aria M, Pecoraro G, Mignogna MD, Leuci S, Adamo D. Salivary Complaints in Burning Mouth Syndrome: A Cross Sectional Study on 500 Patients. J Clin Med 2023; 12:5561. [PMID: 37685630 PMCID: PMC10488611 DOI: 10.3390/jcm12175561] [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: 07/14/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Xerostomia and sialorrhea often accompany Burning Mouth Syndrome (BMS) despite no change in saliva quantity. This study analyzed BMS patients with different symptom combinations: burning only (B), burning and xerostomia (BX), burning and sialorrhea (BS), and burning with xerostomia and sialorrhea (BXS), using a large sample of 500 patients from the University of Naples Federico II. METHODS After a medical evaluation, patients were divided into four groups based on their reported symptoms: B (140), BX (253), BS (49), and BXS (58). Patient data on education, BMI, smoking/alcohol habits, comorbidities, medication use, pain intensity, quality, and psychological profile were collected. RESULTS The BX group showed a higher prevalence of patients taking blood thinners. Additional symptoms varied among groups, with the BX group experiencing more dysgeusia and globus, and the BS group reporting more tingling. Multivariate analysis identified BMI, dysgeusia, globus, and blood thinner use as significant factors in the B and BX groups, while male gender, tingling, alcohol use, and pain quality were significant in the BS and BXS groups. CONCLUSIONS Overall, BMS patients display a complex range of symptoms, with xerostomia being the most frequent additional symptom. Sociodemographic, psychological, and medical factors cannot fully explain the variations in symptomatology among different patient subgroups. Further research is needed to understand the underlying causes and develop tailored treatment approaches.
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Affiliation(s)
- Federica Canfora
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (F.C.); (D.A.)
| | - Elena Calabria
- Department of Health Sciences, School of Dentistry, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Gianrico Spagnuolo
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (F.C.); (D.A.)
- Therapeutic Dentistry Department, Institute for Dentistry, Sechenov University, 119991 Moscow, Russia
| | - Noemi Coppola
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (F.C.); (D.A.)
| | - Niccolò Giuseppe Armogida
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (F.C.); (D.A.)
| | - Cristina Mazzaccara
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy
- CEINGE Advanced Biotechnologies, 80145 Naples, Italy
| | - Domenico Solari
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (F.C.); (D.A.)
| | - Luca D’Aniello
- Department of Social Sciences, University Federico II of Naples, 80138 Naples, Italy
| | - Massimo Aria
- Department of Economics and Statistics, University Federico II of Naples, 80138 Naples, Italy
| | - Giuseppe Pecoraro
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (F.C.); (D.A.)
| | - Michele Davide Mignogna
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (F.C.); (D.A.)
| | - Stefania Leuci
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (F.C.); (D.A.)
| | - Daniela Adamo
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (F.C.); (D.A.)
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Chen CR, Su YC, Chen HC, Lin YC. Botulinum Toxin for Drooling in Adults with Diseases of the Central Nervous System: A Meta-Analysis. Healthcare (Basel) 2023; 11:1956. [PMID: 37444790 DOI: 10.3390/healthcare11131956] [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: 03/29/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: The purpose of this study was to determine whether the drooling of adult patients with diverse central nervous system diseases can be treated with botulinum toxin type A. (2) Methods: The Cochrane Library, MEDLINE, and Embase were all searched for studies that fit the inclusion criteria. The patients in the studies had to be adults (>18 years old), and the studies had to be randomized placebo-controlled trials, controlled trials, or prospective studies. Each study had to have enough quantifiable data available for meta-analysis. The primary outcome measure was the Drooling Severity and Frequency Scale (DSFS). (3) Results: The meta-analysis comprised three studies. A statistically significant difference in DSFS score between the treatment and control groups was observed in the meta-analysis, with an overall standardized mean difference of -0.9377 (95% CI, -1.2919 to -0.5836; p < 0.0001). A total of seven studies were ineligible for inclusion in the meta-analysis and were only assessed as qualitative data. All qualitative studies showed a significant reduction in DSFS score a few weeks or months after the injection of botulinum toxin. (4) Conclusions: Botulinum toxin type A is safe and effective as a treatment for drooling in adult patients with central nervous system diseases.
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Affiliation(s)
- Chih-Rung Chen
- School of Medicine, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan
| | - Yu-Chi Su
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Hui-Chuan Chen
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan
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Qamar MA, Rota S, Batzu L, Subramanian I, Falup-Pecurariu C, Titova N, Metta V, Murasan L, Odin P, Padmakumar C, Kukkle PL, Borgohain R, Kandadai RM, Goyal V, Chaudhuri KR. Chaudhuri's Dashboard of Vitals in Parkinson's syndrome: an unmet need underpinned by real life clinical tests. Front Neurol 2023; 14:1174698. [PMID: 37305739 PMCID: PMC10248458 DOI: 10.3389/fneur.2023.1174698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
We have recently published the notion of the "vitals" of Parkinson's, a conglomeration of signs and symptoms, largely nonmotor, that must not be missed and yet often not considered in neurological consultations, with considerable societal and personal detrimental consequences. This "dashboard," termed the Chaudhuri's vitals of Parkinson's, are summarized as 5 key vital symptoms or signs and comprise of (a) motor, (b) nonmotor, (c) visual, gut, and oral health, (d) bone health and falls, and finally (e) comorbidities, comedication, and dopamine agonist side effects, such as impulse control disorders. Additionally, not addressing the vitals also may reflect inadequate management strategies, leading to worsening quality of life and diminished wellness, a new concept for people with Parkinson's. In this paper, we discuss possible, simple to use, and clinically relevant tests that can be used to monitor the status of these vitals, so that these can be incorporated into clinical practice. We also use the term Parkinson's syndrome to describe Parkinson's disease, as the term "disease" is now abandoned in many countries, such as the U.K., reflecting the heterogeneity of Parkinson's, which is now considered by many as a syndrome.
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Affiliation(s)
- Mubasher A. Qamar
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Silvia Rota
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Lucia Batzu
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Indu Subramanian
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Parkinson’s Disease Research, Education and Clinical Centers, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, United States
| | - Cristian Falup-Pecurariu
- Faculty of Medicine, Transilvania University of Braşov, Brașov, Romania
- Department of Neurology, County Clinic Hospital, Brașov, Romania
| | - Nataliya Titova
- Department of Neurology, Neurosurgery and Medical Genetics, Federal State Autonomous Educational Institution of Higher Education “N.I. Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation, Moscow, Russia
- Department of Neurodegenerative Diseases, Federal State Budgetary Institution “Federal Center of Brain Research and Neurotechnologies” of the Federal Medical Biological Agency, Moscow, Russia
| | - Vinod Metta
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Lulia Murasan
- Faculty of Medicine, Transilvania University of Braşov, Brașov, Romania
- Department of Neurology, County Clinic Hospital, Brașov, Romania
| | - Per Odin
- Department of Neurology, University Hospital, Lund, Sweden
| | | | - Prashanth L. Kukkle
- Center for Parkinson’s Disease and Movement Disorders, Manipal Hospital, Karnataka, India, Bangalore
- Parkinson’s Disease and Movement Disorders Clinic, Bangalore, Karnataka, India
| | - Rupam Borgohain
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Rukmini Mridula Kandadai
- Department of Neurology, Nizam’s Institute of Medical Sciences, Autonomous University, Hyderabad, India
| | - Vinay Goyal
- Neurology Department, Medanta, Gurugram, India
| | - Kallo Ray Chaudhuri
- Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
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Metta V, Chung-Faye G, Ts Benamer H, Mrudula R, Goyal V, Falup-Pecurariu C, Muralidharan N, Deepak D, Abdulraheem M, Borgohain R, Chaudhuri KR. Hiccups, Hypersalivation, Hallucinations in Parkinson's Disease: New Insights, Mechanisms, Pathophysiology, and Management. J Pers Med 2023; 13:jpm13050711. [PMID: 37240881 DOI: 10.3390/jpm13050711] [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: 03/06/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023] Open
Abstract
Parkinson's disease (PD) is a chronic, progressive neurological disorder and the second most common neurodegenerative condition. We report three common but overlooked symptoms in PD-hiccups, hypersalivation, and hallucinations-in terms of their prevalence, pathophysiology, and up-to-date evidence-based treatment strategies. Whilst all these three symptoms do occur in many other neurological and non-neurological conditions, early recognition and treatment are paramount. Whilst hiccups affect 3% of healthy people, their rate of occurrence is higher (20%) in patients with PD. Hypersalivation (Sialorrhea) is another common neurological manifestation of many neurological and other neurodegenerative conditions such as motor neuron disease (MND), with a median prevalence rate of 56% (range: 32-74%). A 42% prevalence of sialorrhea is also reported in sub-optimally treated patients with PD. Hallucinations, especially visual hallucinations, are commonly reported, with a prevalence of 32-63% in PD, and a 55-78% prevalence is noted in patients with dementia with Lewy bodies (DLB), followed by tactile hallucinations, which are indicated by a sensation of crawling bugs or imaginary creatures across the skin surface. Whilst mainstay and primary management strategies for all these three symptoms are carried out through history taking, it is also essential to identify and treat possible potential triggers such as infection, minimise or avoid causative (such as drug-induced) factors, and especially carry out patient education before considering more definitive treatment strategies, such as botulinum toxin therapies for hypersalivation, to improve the quality of life of patients. This original review paper aims to provide a comprehensive overview of the disease mechanisms, pathophysiology, and management of hiccups, hypersalivation, and hallucinations in Parkinson's disease.
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Affiliation(s)
- Vinod Metta
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London WC2R 2LS, UK
- Kings College Hospital London, Dubai 263267, United Arab Emirates
| | - Guy Chung-Faye
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London WC2R 2LS, UK
- Kings College Hospital London, Dubai 263267, United Arab Emirates
| | - Hani Ts Benamer
- Department of Movement Disorders & Parkinson's Centre of Excellence, Mohammed Bin Rashid University, Dubai 263267, United Arab Emirates
| | - Rukmini Mrudula
- CNC Institute of Movement Disorders & Parkinson's Centre of Excellence, India
| | - Vinay Goyal
- Institute of Movement Disorders, Medanta Hospitals, India
| | | | | | - Desh Deepak
- Kings College Hospital London, Dubai 263267, United Arab Emirates
| | | | - Rupam Borgohain
- CNC Institute of Movement Disorders & Parkinson's Centre of Excellence, India
| | - Kallol Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London WC2R 2LS, UK
- Kings College Hospital London, Dubai 263267, United Arab Emirates
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Development of the Korean Version of the Drooling Infants and Preschoolers Scale. Occup Ther Int 2023. [DOI: 10.1155/2023/7082782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objective. This study is aimed at translating and cross-culturally adapting the Drooling Infants and Preschoolers Scale (DRIPS) into Korean cultural context and examine the content validity and reliability of the Korean version, which is referred as K-DRIPS. Methods. An iterative forward-backward translation sequence of the DRIPS was performed by 20 Korean health professional experts (i.e., occupational therapists (OTs) and professors) with more than 10 years of experience. The study subjects were 77 children with cerebral palsy (CP) exhibiting drooling symptoms aged 2-7 years. They were recruited from two children’s rehabilitation hospitals in Korea and completed the K-DRIPS. The content validity and internal consistency of the K-DRIPS items were examined. Results. An assessment with 20 K-DRIPS items was adequately and cross-culturally adapted into Korea. All the items exhibited good content validity (content validity ratio range 4.00-4.95) and good internal consistency (Cronbach’s
). Conclusion. The study findings indicated that the K-DRIPS was successfully adapted to the Korean cultural context and demonstrated good psychometric properties. This instrument could be used for drooling assessment tool in Korean children with disabilities.
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James E, Ellis C, Brassington R, Sathasivam S, Young CA. Treatment for sialorrhea (excessive saliva) in people with motor neuron disease/amyotrophic lateral sclerosis. Cochrane Database Syst Rev 2022; 5:CD006981. [PMID: 35593746 PMCID: PMC9121913 DOI: 10.1002/14651858.cd006981.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Motor neuron disease (MND), also known as amyotrophic lateral sclerosis (ALS), is a progressive neurodegenerative condition that may cause dysphagia, as well as limb weakness, dysarthria, emotional lability, and respiratory failure. Since normal salivary production is 0.5 L to 1.5 L daily, loss of salivary clearance due to dysphagia leads to salivary pooling and sialorrhea, often resulting in distress and inconvenience to people with MND. This is an update of a review first published in 2011. OBJECTIVES To assess the effects of treatments for sialorrhea in MND, including medications, radiotherapy and surgery. SEARCH METHODS On 27 August 2021, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, AMED, CINAHL, ClinicalTrials.gov and the WHO ICTRP. We checked the bibliographies of the identified randomized trials and contacted trial authors as needed. We contacted known experts in the field to identify further published and unpublished papers. SELECTION CRITERIA We included randomized controlled trials (RCTs) and quasi-RCTs, including cross-over trials, on any intervention for sialorrhea and related symptoms, compared with each other, placebo or no intervention, in people with ALS/MND. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We identified four RCTs involving 110 participants with MND who were described as having intractable sialorrhea or bulbar dysfunction. A well-designed study of botulinum toxin B compared to placebo injected into the parotid and submandibular glands of 20 participants showed that botulinum toxin B may produce participant-reported improvement in sialorrhea, but the confidence interval (CI) was also consistent with no effect. Six of nine participants in the botulinum group and two of nine participants in the placebo group reported improvement (risk ratio (RR) 3.00, 95% CI 0.81 to 11.08; 1 RCT; 18 participants; low-certainty evidence). An objective measure indicated that botulinum toxin B probably reduced saliva production (in mL/5 min) at eight weeks compared to placebo (MD -0.50, 95% CI -1.07 to 0.07; 18 participants, moderate-certainty evidence). Botulinum toxin B may have little to no effect on quality of life, measured on the Schedule for Evaluation of Individual Quality of Life direct weighting scale (SEIQoL-DW; 0-100, higher values indicate better quality of life) (MD -2.50, 95% CI -17.34 to 12.34; 1 RCT; 17 participants; low-certainty evidence). The rate of adverse events may be similar with botulinum toxin B and placebo (20 participants; low-certainty evidence). Trialists did not consider any serious events to be related to treatment. A randomized pilot study of botulinum toxin A or radiotherapy in 20 participants, which was at high risk of bias, provided very low-certainty evidence on the primary outcome of the Drool Rating Scale (DRS; range 8 to 39 points, higher scores indicate worse drooling) at 12 weeks (effect size -4.8, 95% CI -10.59 to 0.92; P = 0.09; 1 RCT; 16 participants). Quality of life was not measured. Evidence for adverse events, measured immediately after treatment (RR 7.00, 95% CI 1.04 to 46.95; 20 participants), and after four weeks (when two people in each group had viscous saliva) was also very uncertain. A phase 2, randomized, placebo-controlled cross-over study of 20 mg dextromethorphan hydrobromide and 10 mg quinidine sulfate (DMQ) found that DMQ may produce a participant-reported improvement in sialorrhea, indicated by a slight improvement (decrease) in mean scores for the primary outcome, the Center for Neurologic Study Bulbar Function Scale (CNS-BFS). Mean total CNS-BFS (range 21 (no symptoms) to 112 (maximum symptoms)) was 53.45 (standard error (SE) 1.07) for the DMQ treatment period and 59.31 (SE 1.10) for the placebo period (mean difference) MD -5.85, 95% CI -8.77 to -2.93) with a slight decrease in the CNS-BFS sialorrhea subscale score (range 7 (no symptoms) to 35 (maximum symptoms)) compared to placebo (MD -1.52, 95% CI -2.52 to -0.52) (1 RCT; 60 participants; moderate-certainty evidence). The trial did not report an objective measure of saliva production or measure quality of life. The study was at an unclear risk of bias. Adverse events were similar to other trials of DMQ, and may occur at a similar rate as placebo (moderate-certainty evidence, 60 participants), with the most common side effects being constipation, diarrhea, nausea, and dizziness. Nausea and diarrhea on DMQ treatment resulted in one withdrawal. A randomized, double-blind, placebo-controlled cross-over study of scopolamine (hyoscine), administered using a skin patch, involved 10 randomized participants, of whom eight provided efficacy data. The participants were unrepresentative of clinic cohorts under routine clinical care as they had feeding tubes and tracheostomy ventilation, and the study was at high risk of bias. The trial provided very low-certainty evidence on sialorrhea in the short term (7 days' treatment, measured on the Amyotrophic Lateral Scelerosis Functional Rating Scale-Revised (ALSFRS-R) saliva item (P = 0.572)), and the amount of saliva production in the short term, as indicated by the weight of a cotton roll (P = 0.674), or daily oral suction volume (P = 0.69). Quality of life was not measured. Adverse events evidence was also very uncertain. One person treated with scopolamine had a dry mouth and one died of aspiration pneumonia considered unrelated to treatment. AUTHORS' CONCLUSIONS There is some low-certainty or moderate-certainty evidence for the use of botulinum toxin B injections to salivary glands and moderate-certainty evidence for the use of oral dextromethorphan with quinidine (DMQ) for the treatment of sialorrhea in MND. Evidence on radiotherapy versus botulinum toxin A injections, and scopolamine patches is too uncertain for any conclusions to be drawn. Further research is required on treatments for sialorrhea. Data are needed on the problem of sialorrhea in MND and its measurement, both by participant self-report measures and objective tests. These will allow the development of better RCTs.
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Affiliation(s)
- Eleanor James
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Cathy Ellis
- Motor Nerve Clinic, Academic Neurosciences Centre, King's College Hospital, London, UK
| | - Ruth Brassington
- Cochrane Neuromuscular, Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
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You P, Strychowsky J, Gandhi K, Chen BA. Anticholinergic treatment for sialorrhea in children: A systematic review. Paediatr Child Health 2022; 27:82-87. [PMID: 35599670 PMCID: PMC9113838 DOI: 10.1093/pch/pxab051] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/09/2021] [Indexed: 08/27/2023] Open
Abstract
Background Sialorrhea in children can be associated with adverse physical and social effects. Treatment using anticholinergic medications has been shown to offer symptomatic relief, but there is no consensus regarding which treatment is the most efficacious. Objective To examine the effectiveness of anticholinergic medications for sialorrhea in children. Methods A systematic review was carried out in Medline, EMBASE, Cochrane, Scopus, and the Web of Science from inception until April 29, 2020. Studies reporting original data on the efficacy of anticholinergic medications in the management of sialorrhea in children aged 0 to 17 years of age were included. This review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards. Data on study design, setting, population, pharmacologic intervention(s), comparator(s), outcomes, and results were extracted and summarized. Results The search strategy identified 2,800 studies of which 27 articles were included in the synthesis, including five randomized controlled trials. Each anticholinergic undergoing experimental study (glycopyrrolate, scopolamine/hyoscine, trihexyphenidyl/benzhexol, benztropine, and atropine) showed evidence of efficacy. Adverse side effects were common. Significant heterogeneity exists in the studies' methodology and the variability of outcome measures used between studies precluded a meta-analysis. Conclusions Glycopyrrolate, scopolamine/hyoscine, trihexyphenidyl/benzhexol, benztropine, and atropine have all shown efficacy in the treatment of sialorrhea in children. The small number of reports and the variability in study design precluded a meta-analysis. More studies are needed with uniformity in outcome measures to help guide evidence-based decision making. A guidance table is presented.
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Affiliation(s)
- Peng You
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Julie Strychowsky
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Karan Gandhi
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Breanna A Chen
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Children’s Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
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13
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Pathophysiology and Symptomatology of Drooling in Parkinson’s Disease. Healthcare (Basel) 2022; 10:healthcare10030516. [PMID: 35326994 PMCID: PMC8951596 DOI: 10.3390/healthcare10030516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 12/29/2022] Open
Abstract
Drooling can present in patients with Parkinson’s disease (PD), and it is manifested as an excessive pooling of saliva inside the oral cavity. Currently, the exact pathophysiological mechanism of drooling in PD is not yet fully explicated. Thus, it becomes crucial to understand if some clinical characteristics may emphasize drooling or if they are just concomitant. In PD, excessive drooling has been associated with a higher burden of non-motor symptoms, such as cognitive impairment, sleep problems, autonomic dysfunction, constipation and orthostatic hypotension, and of worse severity of motor fluctuations and bradykinesia. PD patients with excessive drooling also showed a reduction of striatal DAT availability at DaTSCAN imaging. Excessive drooling in patients with Parkinson’s cannot be attributed to a single factor but to a mixture of factors, including but not limited to impaired nigrostriatal pathways.
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Steenbakkers R, van Doornik S, Vissink A, Kerdijk W, van Laar T. Radiation of parotid or submandibular glands is effective for drooling in patients with parkinsonism; a randomised double-blind placebo-controlled trial. Clin Park Relat Disord 2022; 6:100138. [PMID: 35243319 PMCID: PMC8861815 DOI: 10.1016/j.prdoa.2022.100138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 12/29/2021] [Accepted: 02/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background Drooling is a common symptom in patients with parkinsonism, causing physical and emotional distress. It is unknown which major salivary glands are the best candidates for irradiation to reduce drooling with minimal adverse events. Therefore, this study assessed the efficacy and safety of submandibular and parotid salivary gland irradiation to reduce drooling. Methods A prospective, randomised, double-blind, placebo-controlled trial was conducted at the University Medical Center Groningen, the Netherlands. After informed consent, 31 patients with parkinsonism and severe drooling according to the Unified Parkinson Disease Rating Scale (UPDRS) were included in this study. Exclusion criteria consisted of the use of anticholinergic drugs, the existence of salivary gland diseases, and/or an history of (pre)malignancies of the salivary glands. Patients were randomized for parotid-, submandibular- or sham irradiation (2x6 Gy with one week interval). Patients were evaluated at 1, 3, 6 and 12 months after radiation. Primary outcome measure was drooling severity according to the UPDRS. Secondary outcomes measures consisted of stimulated glandular salivary secretion rates and adverse effects. Findings Overall 31 parkinsonian patients were included. Initially 11 patients were radiated on the parotid glands, 10 patients on the submandibular glands and 10 patients were sham-radiated. After 6 months, the sham-radiated patients were actively treated after a second randomisation. One patient in the parotid radiation group discontinued his participation after three months due to physical deterioration. Radiation of parotid or submandibular glands significantly improved the existing drooling, as compared to placebo radiation. Parotid- and submandibular radiation was equally effective, but more patients in the submandibular radiated group reported sticky saliva vs. patients treated by parotid radiation (33∙33% vs. 13∙33%). Interpretation Major salivary gland radiation significantly improves drooling in parkinsonian patients with few adverse effects. However, parotid gland radiation is accompanied by fewer side effects and therefore is the preferred mode of radiation in this patient population.
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Affiliation(s)
- R.J.H.M. Steenbakkers
- Department of Radiotherapy, University of Groningen, University Medical Center Groningen, the Netherlands
- Corresponding author.
| | - S.P. van Doornik
- Department of Dental Medicine, University of Groningen, Groningen, the Netherlands
| | - A. Vissink
- Department of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
| | - W. Kerdijk
- Department of Dental Medicine, University of Groningen, Groningen, the Netherlands
| | - T. van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands
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15
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Oral Lesions in Children and Adolescents. Pediatr Dent 2022. [DOI: 10.1007/978-3-030-78003-6_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Bekkers S, Pruijn IMJ, van der Burg JJW, van Hulst K, Kok SE, Delsing CP, Scheffer ART, van den Hoogen FJA. Surgery versus botulinum neurotoxin A to reduce drooling and improve daily life for children with neurodevelopmental disabilities: a randomized controlled trial. Dev Med Child Neurol 2021; 63:1351-1359. [PMID: 33997959 PMCID: PMC8597158 DOI: 10.1111/dmcn.14924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/28/2022]
Abstract
AIM To compare the effect of bilateral submandibular duct ligation and botulinum neurotoxin A (BoNT-A) on drooling severity and its impact on daily life and care in children and adolescents with moderate-to-severe drooling. METHOD This was a randomized, interventional, controlled trial in which 53 children and adolescents (31 males, 22 females, mean age 11y, range 8-22y, SD 2y 10mo) with cerebral palsy (58.5%) or other non-progressive developmental disorders (41.5%) were randomized to BoNT-A (n=26) or bilateral submandibular duct ligation (n=27). A parent questionnaire on the severity of drooling in specific positions and daily activities and the impact of drooling on daily life and care was filled out at baseline and 8 and 32 weeks posttreatment. RESULTS Both BoNT-A and bilateral submandibular duct ligation had a positive effect on daily care, damage to electronic equipment and/or furniture, social interactions, and self-esteem. However, bilateral submandibular duct ligation had a significant greater and longer-lasting short- (8wks) and medium-term (32wks) effect on daily care, reducing damage to electronic devices, and improving social interactions and satisfaction with life in general. INTERPRETATION This randomized controlled trial confirms reduced drooling by both BoNT-A and bilateral submandibular duct ligation, but provides new evidence on improved well-being through a reduction in drooling. Even though there is a greater risk of complications and morbidity after bilateral submandibular duct ligation, compared to BoNT-A there was a significantly greater and longer-lasting positive effect on most outcomes. What this paper adds Bilateral botulinum neurotoxin A (BoNT-A) and submandibular duct ligation had a positive effect on the well-being of individuals with moderate-to-severe drooling. Bilateral submandibular duct ligation had a greater effect on the impact of drooling during daily care than BoNT-A. Bilateral submandibular duct ligation reduced damage to electronic devices and improved social interactions and satisfaction with life.
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Affiliation(s)
- Stijn Bekkers
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Ineke M J Pruijn
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Jan J W van der Burg
- Department of Pediatric RehabilitationSint MaartenskliniekNijmegenthe Netherlands,School of Pedagogical and Educational ScienceRadboud UniversityNijmegenthe Netherlands
| | - Karen van Hulst
- Department of RehabilitationRadboud University Medical CenterDonders Institute for Brain, Cognition and BehaviourNijmegenthe Netherlands
| | - Saskia E Kok
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Corinne P Delsing
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Arthur R T Scheffer
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
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Zhang HL, Zhu JE, Li JX, Li XL, Sun LP, Xu HX, Yu SY. US-guided percutaneous microwave ablation (MWA) of submandibular gland: A new minimal invasive and effective treatment for refractory sialorrhea and treatment response evaluation with contrast-enhanced imaging techniques. Clin Hemorheol Microcirc 2021; 78:215-226. [PMID: 33682703 DOI: 10.3233/ch-211115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A 33 years' old male complained of excessive salivation with frequent swallowing and spitting, which resulted in communication disturbance, reduced quality of life, and social embarrassment for 19 years. He had been diagnosed as sialorrhea and submandibular gland hyperfunction by stomatologist, then had unilateral submandibular gland resection 13 years ago, but the symptom relief was not satisfactory. After that, he had been treated with glycopyrrolate for less than a year, which was withdrawn because of the short duration of symptomatic control after each tablet take-in and intolerable side effects. With the wish to receive a new treatment with long term effectiveness, low re-operation risk and normal preserved saliva secretion function, the patient was subject to MWA for the right submandibular gland. After systematic clinical evaluation, US-guided percutaneous MWA was successfully performed with an uneventful post-operative course. The volume of the right submandibular gland and ablated area were measured precisely by an ablation planning software system with automatic volume measurement function based on three-dimensional reconstruction of the pre-operative and post-operative enhanced magnetic resonance imaging (MRI) raw data. Finally, the ablated volume was calculated as 62.2% of the whole right submandibular gland. The patient was discharged 1 day after the operation, with symptoms relieved significantly, the mean value of whole saliva flow rate (SFR) decreased from 11 ml to 7.5 ml per 15 minutes. During the follow up by phone three months after operation, the patient reported that the treatment effect was satisfactory, whereas the SFR value became stable as 7 ml per 15 minutes, drooling frequency and drooling severity (DFDS) score decreased from 6 to 5, drooling impact scale (DIS) score decreased from 43 to 26. US-guided percutaneous MWA of submandibular gland seems to be an alternative, minimal invasive, and effective treatment for refractory sialorrhea.We described a patient with refractory sialorrhea treated successfully with ultrasound (US) guided percutaneous microwave ablation (MWA).
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Affiliation(s)
- Hui-Li Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Jing-E Zhu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Jia-Xin Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Song-Yuan Yu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
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Nascimento D. Clinical features associated with drooling in Parkinson's disease. Neurol Sci 2021; 42:895-903. [PMID: 33443673 DOI: 10.1007/s10072-020-05005-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 12/16/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Drooling is characterized by an excessive pooling of saliva in the oral cavity. The exact pathophysiological mechanism of drooling in Parkinson's disease (PD) is not yet fully understood. OBJECTIVE To identify the relationship between drooling and other clinical features in people diagnosed with PD. METHOD Research on the topic was carried out on the PubMed and ScienceDirect electronic databases. Articles published between March 2015 and March 2020 were selected. Search terms and inclusion and exclusion criteria were previously defined. The articles included met those requirements. RESULTS Sixteen articles were included for analysis. The prevalence of drooling varies between 9.26 and 70% and can occur at any stage of the disease. Higher prevalence of drooling is related to disease duration, disease severity, older age, male, levodopa equivalent dose, hypomimia, dysphagia, dysarthria, cognition, sleep, non-dominant tremor, motor fluctuations, bradykinesia, more symmetric pattern, gastrointestinal and urinary problems, sexual dysfunction, obstipation, and orthostatic hypotension. However, it is not related to hallucinations, rapid eye movement sleep behavior disorder, akinetic-rigid PD, mixed, nor dyskinesias. CONCLUSION Drooling is not caused by a single factor; it is influenced and related to several clinical features. Some clinical factors participate in the onset of drooling while others are concomitant.
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Affiliation(s)
- David Nascimento
- Hospital de Egas Moniz - Centro Hospitalar Lisboa Ocidental, Rua da Junqueira n°126, 1349-019, Lisbon, Portugal.
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Varley LP, Gooney M, Denieffe S, Murphy A. Sialorrhoea Management Practices in Residential Older Adults Care Settings: A Qualitative Study. J Nurs Manag 2020; 29:989-997. [PMID: 33316108 DOI: 10.1111/jonm.13236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/27/2020] [Accepted: 12/09/2020] [Indexed: 01/26/2023]
Abstract
AIM The aim of this research was to explore both older adults' and health care professionals' experience and views of sialorrhoea management practices in older adult residential care settings. BACKGROUND Sialorrhoea is quite a bothersome symptom among patients with certain neurological conditions. The complexity of sialorrhoea and its complications can be quite challenging for health care professionals. In the management of sialorrhoea, a multidisciplinary approach is proposed as an effective way of sialorrhoea management. METHODS Thematic analysis of collected data via semi-structured qualitative interviews with five focus groups involving 28 multidisciplinary health care members and 1 patient. RESULTS The older adult and multidisciplinary health care professionals' view of the management of sialorrhoea in residential care settings were established under three main themes: 1) 'Sialorrhoea compromising patient's dignity', 2) 'Ad hoc local management' and 3) 'Further integration of care required'. CONCLUSION At present, there have been no comprehensive multidisciplinary sialorrhoea management strategies to meet the various needs of older adults with sialorrhoea. IMPLICATION FOR NURSING MANAGEMENT It is important to minimize the negative impact of sialorrhoea on the patients. The recognition of issues associated with sialorrhoea provides constructive scope for the health care professionals to further investigate and develop more effective integrated sialorrhoea care protocols.
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Affiliation(s)
- Li Ping Varley
- Department of Nursing, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - Martina Gooney
- Department of Nursing and Health Care, Waterford Institute of Technology, Ireland
| | - Suzanne Denieffe
- School of Humanities, Waterford Institute of Technology, Ireland
| | - Annette Murphy
- Department of Nursing, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
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Wang B, Su M, Liu Y, Han Z, Qin L. Primary sialorrhea and its surgical treatment with denervation of the submandibular glands in combination with sublingual gland excision. J Craniomaxillofac Surg 2020; 49:47-51. [PMID: 33261985 DOI: 10.1016/j.jcms.2020.11.006] [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: 04/10/2020] [Revised: 09/12/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the effectiveness of ablating postganglionic parasympathetic fibers of the submandibular ganglion in combination with sublingual gland excision in the treatment of primary sialorrhea. MATERIALS AND METHODS Healthy volunteers were initially chosen to determine a basic saliva flow rate value by saliva collection. Next, unstimulated and stimulated saliva flow rates, and a visual analog scale index for sialorrhea were recorded in all the patients pre- and postoperatively. In addition, the generalized anxiety disorder scale was used to assess preoperative anxiety symptoms. The follow-up durations ranged from 24 to 36 months after surgery. RESULTS A total of 10 patients were included in this study. Preoperatively, the mean unstimulated saliva flow rate for the 10 patients was 11.26 ± 4.19 ml/10 min, the stimulated saliva flow rate was 16.76 ± 3.49 ml/6 min, and the visual analog scale index was 66.29 ± 14.86. Postoperatively, the mean unstimulated and stimulated saliva flow rates were significantly reduced to 5.99 ± 1.33 ml/10 min (p = 0.001) and 13.28 ± 1.86 ml/6 min (p = 0.013), respectively, and the visual analog scale index was 25.41 ± 5.6 (p < 0.001). No complications were found after operation. CONCLUSION This study demonstrates that ablation of postganglionic parasympathetic fibers of the submandibular ganglion in combination with sublingual gland excision by an intraoral approach is a simple, safe, and efficient approach for treating primary sialorrhea.
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Affiliation(s)
- Bin Wang
- Department of Oral and Maxillofacial & Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China
| | - Ming Su
- Department of Oral and Maxillofacial & Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China
| | - Yanbin Liu
- Department of Oral and Maxillofacial & Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China
| | - Zhengxue Han
- Department of Oral and Maxillofacial & Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China
| | - Lizheng Qin
- Department of Oral and Maxillofacial & Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, 100050, China.
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Bard-Pondarré R, Roumenoff F, Julien C, Grguric G, Porte M, Boulay C, Bourg V, Chaléat-Valayer E. Validity, reliability and responsiveness to change of the French version of the drooling impact scale. Disabil Rehabil 2020; 44:788-794. [PMID: 32552097 DOI: 10.1080/09638288.2020.1777471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND work still needs to be done to measure the impact of sialorrhea on quality of life and define the efficacy of different therapies. The Drooling Impact Scale showed good validity and sensitivity to change, especially after botulinum toxin injection. The aim of this study is to present its French translation and to explore its validity, reliability and responsiveness to change in a group of children with Cerebral Palsy. METHODS multicentre study at six rehabilitation centres in France. Children with Cerebral Palsy aged 4-18 years with sialorrhea problems were included (n = 55), either in a control group (n = 33) or in the intervention group (n = 22, with 3 drug treatment and 19 botulinum toxin injections). The French Drooling Impact Scale was administered twice, 1 month apart. RESULTS The French Drooling Impact Scale total score at inclusion was meanly 53.9 (Standard Deviation 11.9) in the stable control group and 66.0 (16.1) in the intervention group (p = 0.0058). The validity of the scale was established, as well as an adequate internal consistency (Cronbach's α = 0.71); correlations between each item and the total score were found between 0.5 and 0.71 except for item 5 (r = 0.38) and item 7 (0.41). The test-retest reliability in stable children was good (Lin coefficient = 0.83, bias correction factor = 0.92 and Pearson correlation coefficient = 0.89). There was a high responsiveness to change, mean change was -40.0 in the intervention group and -3.6 in the stable group (p < 0.0001), with Standard Error of Measurement = 2.6. CONCLUSION the French Drooling Impact Scale has shown sufficient clinometric properties to be used now by clinicians or researchers.IMPLICATIONS FOR REHABILITATIONThe Drooling Impact scale has now its French version.The French version of the Drooling Impact Scale has shown its validity and a good test-retest reliability.The responsiveness to change was explored in a group of children undergoing saliva-control interventions and the scale was able to show a big change.The authors recommend to use this questionnaire in a semi-directed interview conducted by a health professional.
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Affiliation(s)
| | | | - Christell Julien
- Hospices Civils de Lyon, Pôle Information Médicale, Evaluation, Recherche, Unité d'Evaluation Médico-Economique, Lyon, France
| | - Gwen Grguric
- Hospices Civils de Lyon, Pôle Information Médicale, Evaluation, Recherche, Unité d'Evaluation Médico-Economique, Lyon, France
| | - Mélanie Porte
- CHU de Nîmes, Hôpital Carémeau - Service de rééducation et réadaptation fonctionnelle, Place du Pr Robert Debré, Nîmes, France
| | | | - Véronique Bourg
- CHU - Hôpital Nord, Boulevard de la Chantourne, La Tronche, France
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22
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Mito Y, Yabe I, Yaguchi H, Sato C, Takei T, Terae S, Tajima Y. Relationships of drooling with motor symptoms and dopamine transporter imaging in drug-naïve Parkinson's disease. Clin Neurol Neurosurg 2020; 195:105951. [PMID: 32492588 DOI: 10.1016/j.clineuro.2020.105951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/25/2020] [Accepted: 05/19/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of the present study was to determine the relationships of drooling with motor symptoms and nigrostriatal neuron loss in drug-naïve patients with Parkinson's disease (PD). We therefore examined the relationships of drooling with motor symptoms and striatal dopamine transporter (DAT) binding measured by [123-Iodine]-fluoropropyl-2beta-carbomethoxy-3beta-(4-iodophenylnortropane) dopamine transporter single-photon emission computed tomography(123I-FP-CIT SPECT). PATIENTS AND METHODS Thirty-five untreated PD patients (14 men and 21 women with a mean age of 71.9 ± 7.2 years) were included in this study. The patients were divided into a drooler group and non-drooler group. They underwent clinical assessments and 123I-FP-CIT SPECT imaging. Motor symptoms were assessed using Unified Parkinson's Disease Rating Scale (UPDRS). RESULTS The results showed that UPDRS motor score (p = 0.002) and akinetic-rigid score (p = 0.008) were higher and that striatal DAT availability (p = 0.03) was lower in the drooler group than in the non-drooler group. However, tremor score, age, and duration of PD showed no significant differences between the drooler group and non-drooler group. CONCLUSIONS Drooling in untreated PD is related to an increase in motor symptoms (especially bradykinesia and axial symptoms) and to reduction of striatal DAT availability.
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Affiliation(s)
- Yasunori Mito
- Department of Neurology, Brain Science Center, Sapporo City General Hospital, Kita 11-nishi 13, ChuoKu, Sapporo, Hokkaido, 060-8604, Japan.
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hiroaki Yaguchi
- Department of Neurology, Brain Science Center, Sapporo City General Hospital, Kita 11-nishi 13, ChuoKu, Sapporo, Hokkaido, 060-8604, Japan
| | - Chika Sato
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Toshiki Takei
- Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Satoshi Terae
- Department of Diagnostic Radiology, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Yasutaka Tajima
- Department of Neurology, Brain Science Center, Sapporo City General Hospital, Kita 11-nishi 13, ChuoKu, Sapporo, Hokkaido, 060-8604, Japan
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23
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van Wamelen DJ, Leta V, Johnson J, Ocampo CL, Podlewska AM, Rukavina K, Rizos A, Martinez-Martin P, Chaudhuri KR. Drooling in Parkinson's Disease: Prevalence and Progression from the Non-motor International Longitudinal Study. Dysphagia 2020; 35:955-961. [PMID: 32130515 PMCID: PMC7669801 DOI: 10.1007/s00455-020-10102-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/22/2020] [Indexed: 12/29/2022]
Abstract
Sialorrhoea in Parkinson’s disease (PD) is an often neglected yet key non-motor symptom with impact on patient quality of life. However, previous studies have shown a broad range of prevalence figures. To assess prevalence of drooling in PD and its relationship to quality of life, we performed a retrospective analysis of 728 consecutive PD patients who had a baseline and follow-up assessment as part of the Non-motor International Longitudinal Study (NILS), and for whom drooling presence and severity were available, assessed through the Non-Motor Symptoms Scale (NMSS). In addition, we analysed the prevalence of associated dysphagia through self-reported outcomes. Quality of life was assessed through the PDQ-8 scale. Baseline (disease duration 5.6 years) prevalence of drooling was 37.2% (score ≥ 1 NMSS question 19), and after 3.27 ± 1.74 years follow-up, this was 40.1% (p = 0.17). The prevalence of drooling increased with age (p < 0.001). The severity of drooling, however, did not change (p = 0.12). While in 456 patients without drooling at baseline, only 16% (n = 73) had dysphagia (question 20 of the NMSS), in those with drooling this was 34.3% (p < 0.001). At follow-up, the number of patients with dysphagia had increased, 20.4% with no drooling had dysphagia, and 43.6% with drooling had dysphagia. Both at baseline and follow-up, drooling severity was significantly positively associated with quality of life (PDQ-8; r = 0.199; p < 0.001). In moderately advanced PD patients, subjective drooling occurs in over one-third of patients and was significantly associated with decreased quality of life. Dysphagia occurred significantly more often in patients with drooling.
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Affiliation(s)
- Daniel J van Wamelen
- Institute of Psychiatry, Psychology & Neuroscience, Department of Basic and Clinical Neurosciences, King's College London, De Crespigny Park, London, SE5 8AF, UK. .,Parkinson Foundation Centre of Excellence At King's College Hospital, Denmark Hill, London, SE5 9RS, UK. .,Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - Valentina Leta
- Institute of Psychiatry, Psychology & Neuroscience, Department of Basic and Clinical Neurosciences, King's College London, De Crespigny Park, London, SE5 8AF, UK.,Parkinson Foundation Centre of Excellence At King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Julia Johnson
- Parkinson Foundation Centre of Excellence At King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Claudia Lazcano Ocampo
- Institute of Psychiatry, Psychology & Neuroscience, Department of Basic and Clinical Neurosciences, King's College London, De Crespigny Park, London, SE5 8AF, UK.,Parkinson Foundation Centre of Excellence At King's College Hospital, Denmark Hill, London, SE5 9RS, UK.,Department of Neurology, Hospital Sotero del Rio, Santiago, Chile
| | - Aleksandra M Podlewska
- Institute of Psychiatry, Psychology & Neuroscience, Department of Basic and Clinical Neurosciences, King's College London, De Crespigny Park, London, SE5 8AF, UK.,Parkinson Foundation Centre of Excellence At King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Katarina Rukavina
- Institute of Psychiatry, Psychology & Neuroscience, Department of Basic and Clinical Neurosciences, King's College London, De Crespigny Park, London, SE5 8AF, UK.,Parkinson Foundation Centre of Excellence At King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Alexandra Rizos
- Institute of Psychiatry, Psychology & Neuroscience, Department of Basic and Clinical Neurosciences, King's College London, De Crespigny Park, London, SE5 8AF, UK.,Parkinson Foundation Centre of Excellence At King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, 28031, Madrid, Spain
| | - K Ray Chaudhuri
- Institute of Psychiatry, Psychology & Neuroscience, Department of Basic and Clinical Neurosciences, King's College London, De Crespigny Park, London, SE5 8AF, UK.,Parkinson Foundation Centre of Excellence At King's College Hospital, Denmark Hill, London, SE5 9RS, UK
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24
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Beranger T, Pierache A, Loffer Z, Tiffreau V, Ferri J, Nicot R. Efficacy of injections of botulinum toxin-A for improving drooling and quality of life in disabled patients. Ann Phys Rehabil Med 2019; 63:568-569. [PMID: 31809846 DOI: 10.1016/j.rehab.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/10/2019] [Accepted: 11/10/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Thibaut Beranger
- Department of Oral and Maxillofacial Surgery, University Lille, CHU de Lille, 59000 Lille, France
| | - Adeline Pierache
- EA 2694 - Santé publique: épidemiologie et qualité des soins, University Lille, CHU de Lille, 59000 Lille, France
| | - Zoé Loffer
- Faculty of Pharmacy, University Lille, 59000 Lille, France
| | - Vincent Tiffreau
- EA 7369, Service de médecine physique et réadaptation, Hôpital Swynghedauw, université de Lille, CHU de Lille, Lille, France
| | - Joël Ferri
- Inserm U 1008, Controlled Drug Delivery Systems and Biomaterials, Department of Oral and Maxillofacial Surgery, University Lille, CHU de Lille, 59000 Lille, France
| | - Romain Nicot
- Inserm U 1008, Controlled Drug Delivery Systems and Biomaterials, Department of Oral and Maxillofacial Surgery, University Lille, CHU de Lille, 59000 Lille, France.
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25
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Morgante F, Bavikatte G, Anwar F, Mohamed B. The burden of sialorrhoea in chronic neurological conditions: current treatment options and the role of incobotulinumtoxinA (Xeomin®). Ther Adv Neurol Disord 2019; 12:1756286419888601. [PMID: 31819763 PMCID: PMC6883364 DOI: 10.1177/1756286419888601] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/08/2019] [Indexed: 12/11/2022] Open
Abstract
Sialorrhoea is a frequent symptom of neurological diseases (e.g. Parkinson's disease, motor neuron disease, cerebral palsy, and stroke) and is defined as excessive saliva accumulation leading to unintentional loss of saliva from the mouth. Sialorrhoea increases the overall burden on the patient and their caregivers, the impact of which can be both physical and psychosocial. Treatments for sialorrhoea range from lifestyle and behavioural guidance, to medications, surgery or radiation. Nonpharmacological interventions include advice on posture, swallowing control, cough management, dietary changes, eating and drinking techniques, and behavioural modification; however, these conservative measures may be ineffective for people with progressive neurological conditions. The pharmacological treatment of sialorrhoea is challenging because medications licensed for this purpose are limited, but treatments can include anticholinergic drugs and botulinum toxins. Surgical treatment of sialorrhoea is typically reserved as a last resort for patients. IncobotulinumtoxinA (Xeomin®) is the first botulinum toxin type A to receive US and UK marketing authorization for the symptomatic treatment of chronic sialorrhoea due to neurological disorders in adults. In this review, we discuss and compare the frequency and method of administration, location of treatment delivery, approximate annual costs and main side effects of botulinum toxin and different anticholinergic drugs. Management of patients with chronic neurological conditions requires input from multiple specialist teams and thus a multidisciplinary team (MDT) approach is considered fundamental to ensure that care is consistent and tailored to patients' needs. To ensure that adult patients with neurological conditions receive the best care and sialorrhoea is well managed, we suggest a potential clinical care pathway for sialorrhoea with a MDT approach, which healthcare professionals could aspire to.
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Affiliation(s)
- Francesca Morgante
- Neurosciences Research Centre, Molecular and
Clinical Sciences Research Institute, St George’s University of London,
London, United Kingdom; Department of Experimental and Clinical Medicine,
University of Messina
- Molecular and Clinical Sciences Research
Institute, St George’s University of London, London, United Kingdom Cranmer
Terrace, Jenner Wing, Ground Floor, Corridor 10, Room 0.135, London, SW17
0RE, UK
| | - Ganesh Bavikatte
- Department of Rehabilitation Medicine, The
Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Fahim Anwar
- Department of Rehabilitation Medicine, Cambridge
University Hospital NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge,
UK
| | - Biju Mohamed
- Department of Medicine and Gerontology,
University Hospital of Wales, Cardiff, UK
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26
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McNaney R, Miller N, Vines J, Olivier P, Ladha K, Jackson D, Walker R. The feasibility and acceptability of using a novel wrist worn cueing device to self-manage drooling problems in people with Parkinson's disease: A pilot study. J Rehabil Assist Technol Eng 2019; 6:2055668319852529. [PMID: 31662884 PMCID: PMC6796203 DOI: 10.1177/2055668319852529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 04/27/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction Daytime drooling is experienced by around 50% of Parkinson’s patients, who
fail to swallow saliva in sufficient volume or regularity, despite normal
production. This research explored the feasibility and acceptability of
using a cueing device, to improve drooling. Methods During a four-week intervention, 28 participants were asked to use a cueing
device for 1 h per day. During this time, the device vibrated
once-per-minute, reminding the participant to swallow their saliva. A daily
diary was used to collect self-report around swallowing severity, frequency,
and duration. This was filled out by participants for one week before, four
weeks during and for one week immediately after intervention. Diaries were
also collected for one week during a follow up, carried out four weeks after
intervention finished. Results Participants self-reported benefits in drooling severity
(p = 0.031), frequency (p ≤ 0.001), and
duration (p = 0.001) after using the device. Improvements
were maintained at follow up. Twenty-two participants explicitly reported a
positive benefit to their drooling during exit interview. All felt the
intervention and device were acceptable and usable. Conclusions Using a cueing device for one month had perceived benefit to drooling
severity, frequency and duration in patients with Parkinson’s. Participants
accepted the device and treatment protocol.
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Affiliation(s)
- Roisin McNaney
- School of Computer Science Electrical Engineering and Engineering Maths, University of Bristol, Bristol, UK
| | - Nick Miller
- Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - John Vines
- NORTHLab, Northumbria University, Newcastle upon Tyne, UK
| | - Patrick Olivier
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Karim Ladha
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Jackson
- Open Lab, School of Computing Science, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Walker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
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27
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Abstract
INTRODUCTION Sialorrhoea, which has been defined as excessive amount of saliva in the mouth, can be a debilitating symptom. Psychoactive drugs may cause an increase or decrease in saliva secretion. Antidepressant drugs, especially tricyclic antidepressants and less often serotonin reuptake inhibitors, are often associated with a decrease in salivation and the complaint of dry mouth. CASE PRESENTATION A 46-year-old male patient with complaints of being depressed, lack of motivation, irritability and difficulty in falling asleep was started on sertraline treatment and had trouble with sialorrhoea after the dose increase, without other causes of hypersalivation. DISCUSSION We could not find report of any case with antidepressant-associated sialorrhoea in the literature. Future cases may support a relationship between sertraline and sialorrhoea.
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Affiliation(s)
- Ebru Şahan
- Resident Medical Doctor (MD) in Psychiatry, Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
| | - Tezer Kılıçarslan
- Medical Doctor (MD), Psychiatric Trainee, Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
| | - İsmet Kırpınar
- Professor Doctor in Psychiatry, Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
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28
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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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29
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McInerney MS, Reddihough DS, Carding PN, Swanton R, Walton CM, Imms C. Behavioural interventions to treat drooling in children with neurodisability: a systematic review. Dev Med Child Neurol 2019; 61:39-48. [PMID: 30276810 DOI: 10.1111/dmcn.14048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2018] [Indexed: 11/28/2022]
Abstract
AIM To review the evidence for behavioural interventions to reduce drooling in children with neurodisability. METHOD A detailed search in eight databases sought studies that: (1) included participants aged 0 to 18 years with neurodisability and drooling; (2) provided behavioural interventions targeting drooling or a drooling-related behaviour; and (3) used experimental designs. Two reviewers extracted data from full-text papers independently. Results were tabulated for comparison. The Risk of Bias assessment in N-of-1 Trials scale for single case experimental designs (SCEDs) and the Cochrane risk of bias assessment tool for randomized controlled trials (RCTs) were applied. RESULTS Of an initial yield of 763, seven SCEDs and one RCT were included. Behavioural interventions included the use of reinforcement, prompting, self-management, instruction, extinction, overcorrection, and fading. Each assessed body functions or structures' outcomes (drooling frequency and severity); three included activity outcomes (mouth drying, head control, eye contact, and vocalizations) and none assessed participation or quality of life. While each study reported positive effects of intervention, risk of bias was high. INTERPRETATION Low-level evidence suggests behavioural interventions may be useful for treatment of drooling in children with neurodisability. Well-designed intervention studies are urgently needed to determine effectiveness. WHAT THIS PAPER ADDS Behavioural interventions used to treat drooling included reinforcement, prompting, self-management, extinction, overcorrection, instruction, and fading. Interventions targeted body structures and function-level outcomes and activity-level outcomes. Low-level evidence supports the use of behavioural intervention to treat drooling.
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Affiliation(s)
- Michelle S McInerney
- School of Allied Health, Australian Catholic University, Sydney, New South Wales, Australia
| | - Dinah S Reddihough
- Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia.,NHMRC Centre of Research Excellence in Cerebral Palsy, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul N Carding
- School of Allied Health, Australian Catholic University, Brisbane, Queensland, Australia
| | - Ruth Swanton
- School of Allied Health, Australian Catholic University, Sydney, New South Wales, Australia
| | - Chloe M Walton
- School of Allied Health, Australian Catholic University, Brisbane, Queensland, Australia
| | - Christine Imms
- School of Allied Health and Centre for Disability and Development Research at the Australian Catholic University, Melbourne, Victoria, Australia
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30
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Sjögreen L, Gonzalez Lindh M, Brodén M, Krüssenberg C, Ristic I, Rubensson A, McAllister A. Oral Sensory-Motor Intervention for Children and Adolescents (3-18 Years) With Dysphagia or Impaired Saliva Control Secondary to Congenital or Early-Acquired Disabilities: A Review of the Literature, 2000 to 2016. Ann Otol Rhinol Laryngol 2018; 127:978-985. [PMID: 30296844 DOI: 10.1177/0003489418803963] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES: Dysphagia and impaired saliva control are common in children and adolescents with congenital and developmental disabilities. The aim of the present review was to investigate the evidence base for oral sensory-motor interventions in children and adolescents with dysphagia or impaired saliva control secondary to congenital or early-acquired disabilities and to make recommendations regarding methods for intervention. METHODS: A review of the literature from 2000 to 2016, including oral sensory-motor intervention studies for children and adolescents (3-18 years of age) with dysphagia or impaired saliva control secondary to congenital or early-acquired disabilities, was performed. The literature search included the PubMed, CINAHL, Medline, SpeechBITE, OVID, ERIC, Cochrane, and Google Scholar databases. Primary studies were evaluated on a 4-grade scale using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Twenty primary studies of oral sensory-motor interventions for dysphagia and 6 studies for the treatment of impaired saliva control fulfilled the inclusion criteria. Of these, 3 were randomized, controlled trials. Five systematic reviews and 16 narrative reviews were also included. Limited and moderately strong recommendations were made on the basis of the grading results from the primary studies. The studies reported good results, but study design was often insufficient, and the study groups were small. The systematic reviews confirmed the lack of high scientific support for oral sensory-motor interventions in children and adolescents with congenital and developmental disabilities. CONCLUSIONS: There is an urgent need for high-quality studies that could serve as the basis for strong recommendations relating to oral sensory-motor interventions for children with dysphagia and impaired saliva control.
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Affiliation(s)
- Lotta Sjögreen
- 1 Mun-H-Center Orofacial Resource Centre for Rare Diseases, Public Dental Service, Gothenburg, Sweden
| | | | - Madeleine Brodén
- 3 Child and Adolescent Habilitation Services, Kronoberg County, Växjö, Sweden
| | | | | | - Agneta Rubensson
- 6 The Queen Silvia Children's Hospital, Regional Rehabilitation Centre, Gothenburg, Sweden
| | - Anita McAllister
- 7 Division of Speech and Language Pathology, CLINTEC, Karolinska Institutet, Functional Area Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
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31
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Franco JB, Cacita N, Freua KA, Ortega KL, de Melo Peres MPS. Treatment of drooling with scopolamine in pediatric ICU: A case series report. SPECIAL CARE IN DENTISTRY 2018; 38:362-366. [PMID: 30238487 DOI: 10.1111/scd.12326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/03/2018] [Accepted: 07/13/2018] [Indexed: 11/27/2022]
Abstract
Drooling is a condition that affects patients with difficulties in swallowing, being common in patients with mental, neurological or dysphagic deficiency. This condition is difficult to diagnose, as it is often confused with sialorrhea, and in many cases we have a hyposalivation scenario. Its diagnosis is subjective, which is why scales should be used for the standardization of the evaluation of the degree of drooling before and after the proposed treatment, as the Thomas-Stonell and Greenberg scale. It causes problems such as perioral infections, rashes, wet clothing, leading to social embarrassment, and may be a risk factor for respiratory infections caused by asymptomatic aspiration of saliva. It presents several treatments, among them the pharmacological one, that is dependent of the clinical picture of each patient that must be evaluated daily. This article refers to a series of reports of cases of children in mechanical ventilation by tracheostomy, hospitalized, with clinical diagnosis of drooling, and clinical improvement with the use of scopolamine by gastrostomy, without intercurrences during its use. The objective of this study is to show other professionals the importance of drooling management, and to expose the adopted behavior in the described cases, providing reduction of respiratory infections and improvement of the clinical and social complications resulting from drooling.
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Affiliation(s)
- Juliana Bertoldi Franco
- Hospital Auxiliar de Suzano, Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, Brazil.,Division of Dentistry, Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil
| | - Nadia Cacita
- Division of Dentistry, Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil
| | - Karina Albuquerque Freua
- Division of Dentistry, Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil
| | - Karem López Ortega
- Department of Oral Pathology, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Pedersen A, Sørensen CE, Proctor GB, Carpenter GH. Salivary functions in mastication, taste and textural perception, swallowing and initial digestion. Oral Dis 2018; 24:1399-1416. [PMID: 29645367 DOI: 10.1111/odi.12867] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 12/18/2022]
Abstract
Saliva exerts multiple functions in relation to the initial digestive processes taking place in the upper parts of the gastrointestinal tract. Ingestion of food and beverages, in turn, is a strong stimulus for secretion of saliva with a differential composition depending on the neuronal stimulation pattern. This review paper provides insight into the mechanisms by which saliva acts in relation to taste, mastication, bolus formation, enzymatic digestion and swallowing. Also, the protective functions of saliva including maintenance of dental and mucosal integrity will be discussed as they indirectly influence the digestive process. The final part of this study focuses on the implications of xerostomia and salivary gland dysfunction on gastrointestinal functions.
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Affiliation(s)
- Aml Pedersen
- Section 1, Oral Medicine, Oral Pathology & Clinical Oral Physiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - C E Sørensen
- Section of Oral Biochemistry, Cariology & Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - G B Proctor
- Mucosal & Salivary Biology Division, King's College London Dental Institute, Guy's & St Thomas' Hospitals, London, UK
| | - G H Carpenter
- Mucosal & Salivary Biology Division, King's College London Dental Institute, Guy's & St Thomas' Hospitals, London, UK
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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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Development of the Drooling Infants and Preschoolers Scale (DRIPS) and reference charts for monitoring saliva control in children aged 0–4 years. Infant Behav Dev 2018; 50:247-256. [DOI: 10.1016/j.infbeh.2018.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/07/2017] [Accepted: 01/22/2018] [Indexed: 11/18/2022]
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Bayet K, Chikhani L, Ejeil AL. Therapeutic uses and efficacy of botulinum toxin in orofacial medicine. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2018. [DOI: 10.1051/mbcb/2017030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Botulinum toxin, primarily known for its use in cosmetic surgery, is also used for therapeutic purposes in many medical fields. It works as a muscle relaxant and inhibits glandular secretions. In the orofacial sphere, the use of this toxin is proposed in particular for disabling myofascial pain and aberrant salivary disorders. Methodology: A critical analysis of the literature, based on PUBMED data, concerning the orofacial indications of botulinum toxin was carried out. Results: The literature is abundant regarding the therapeutic interest of this toxin for several oral pathologies, but scientific merits vary markedly from one indication to another. Discussion: The musculorelaxant and antisecretory action of this toxin appears to be demonstrated in the case of bruxism, limitation of the mouth opening and in hypersialorrhea. On the other hand, its medical benefit is still not supported by scientific evidence for masseter hypertrophy, tonicity of the levator labii superioris muscles, sialocele fistulae and Frey's syndrome. Conclusion: Additional high-level studies, unbiased, randomized controlled trials, are required to eliminate the uncertainties that persist about the clinical impact of botulinum toxin and to justify the development of recommendations for good practice valid and credible.
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Park D, Woo SB, Lee DH, Yu KJ, Cho JY, Kim JM, Lee Z. The Correlation Between Clinical Characteristics and Radionuclide Salivagram Findings in Patients With Brain Lesions: A Preliminary Study. Ann Rehabil Med 2017; 41:915-923. [PMID: 29354567 PMCID: PMC5773434 DOI: 10.5535/arm.2017.41.6.915] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/02/2017] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the correlation between radionuclide salivagram findings and clinical characteristics in dysphagic patients with brain lesions. Methods The medical records of 35 dysphagic patients with brain lesions who simultaneously underwent both a videofluoroscopic swallowing study (VFSS) and radionuclide salivagram were analyzed retrospectively. The subjects were divided into two groups according to the presence of aspiration on a salivagram (group A, patients with aspiration on the salivagram; group B, patients with no aspiration on the salivagram). The differences between clinical characteristics and VFSS findings (penetration-aspiration scale [PAS]) between the two groups were analyzed. Results Eleven out of 35 patients displayed salivary aspiration on the radionuclide salivagram. There were no significant differences between the two groups according to age, sex, disease duration, PAS on VFSS and feeding methods (p≥0.05). The incidence of aspiration pneumonia was significantly higher in group A. In a multivariate logistic regression analysis with forward stepwise method, the Mini-Mental State Examination (MMSE) score was the only significant parameter in predicting positive findings in salivagrams (odds ratio=0.760; 95% confidence interval [CI], 0.625–0.923; p=0.006). The area under the receiver operating characteristic curve (AUC) of the MMSE score for positive detection in salivagrams was 0.855 (95% CI, 0.689–0.953; p<0.0001). The optimal cut-off value was 7 for the MMSE score (sensitivity 72.73%, specificity 100%). Conclusion In patients with brain lesions who complain of dysphagia, the MMSE score was correlated with salivary aspiration. If patients present with a score of 7 or less on the MMSE, performing a radionuclide salivagram may helpful for early detection of patients at high risk of aspiration pneumonia induced from salivary aspiration.
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Affiliation(s)
- Donghwi Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Seung Beom Woo
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Dae Hee Lee
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Kwang Jae Yu
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Ju Young Cho
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Jong Min Kim
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Zeeihn Lee
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Korea
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The Effect of Nebulized Glycopyrrolate on Posterior Drooling in Patients with Brain Injury: Two Cases of Different Brain Lesions. Am J Phys Med Rehabil 2017; 96:e155-e158. [PMID: 28081026 DOI: 10.1097/phm.0000000000000669] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Posterior drooling, which can lead to substantial respiratory morbidity, including unexplained lung diseases and recurrent pneumonia, is an important issue in the rehabilitation unit. There are various treatment options for posterior drooling, including pharmacologic therapy, oral motor or behavioral therapy, biofeedback, local glandular injection of botulinum toxin, irradiation, and surgery. Among them, nebulized glycopyrrolate has the following advantages: It is noninvasive and is relatively free of central adverse effects because it does not cross the blood-brain barrier unlike other anticholinergics. Although there has been one case report regarding the effectiveness of nebulized glycopyrrolate for drooling in a motor neuron patient, there have not been any reports on its effectiveness for posterior drooling. Herein, we report two cases (an 82-year-old male bilateral hemiplegic stroke patient and a 1-year-old female cerebral palsy infant with bilaterally spastic hemiplegia of posterior drooling treated with nebulized glycopyrrolate) and identify salivary aspiration and the effect of nebulized glycopyrrolate using radionuclide salivagram. Considering its advantages and effectiveness, nebulized glycopyrrolate should be considered as one of the reliable methods to manage posterior drooling in patients with impaired cognition or swallowing difficulties, such as severe brain injury.
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Dashtipour K, Bhidayasiri R, Chen JJ, Jabbari B, Lew M, Torres-Russotto D. RimabotulinumtoxinB in sialorrhea: systematic review of clinical trials. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2017; 4:9. [PMID: 28593050 PMCID: PMC5460542 DOI: 10.1186/s40734-017-0055-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/04/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to examine the efficacy, safety and dosing practices of rimabotulinumtoxinB (BoNT-B) for the treatment of patients with sialorrhea based on a systematic review of clinical trials. METHODS A systematic literature review was performed to identify randomized controlled trials and other comparative clinical studies of BoNT-B for the treatment of sialorrhea published in English between January 1999 and December 2015. Medical literature databases (PubMed, Cochrane Library, and EMBASE) were searched and a total of 41 records were identified. Of these, six primary publications that evaluated BoNT-B for the treatment of sialorrhea met criteria and were included in the final data report. SYNTHESIS Total BoNT-B doses ranged from 1500 to 4000 units for sialorrhea. Most of the studies in sialorrhea showed statistically significant benefits of BoNT-B versus placebo (range 4-19.2 weeks). BoNT-B was generally well tolerated across the individual studies; most adverse events reported were considered unrelated to treatment. Adverse events considered potentially associated with BoNT-B included: dry mouth, change in saliva thickness, mild transient dysphagia, mild weakness of chewing and diarrhea. CONCLUSIONS BoNT-B significantly reduces sialorrhea at doses between 1500 and 4000 units. The relatively mild dose-dependent adverse events suggest both direct and remote toxin effects.
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Affiliation(s)
- Khashayar Dashtipour
- Division of Movement Disorders, Department of Neurology/Movement Disorders, Loma Linda University School of Medicine, Faculty of Medical Offices, 11370 Anderson, Suite B-100, Loma Linda, CA USA
| | - Roongroj Bhidayasiri
- Department of Medicine, Chulalongkorn Center of Excellence for Parkinson’s Disease & Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand
- Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan
| | - Jack J. Chen
- Department of Neurology, Loma Linda University School of Medicine, Loma Linda, CA USA
- Loma Linda University, School of Pharmacy, Loma Linda, CA USA
| | - Bahman Jabbari
- Department of Neurology, Yale University School of Medicine, New Haven, CT USA
| | - Mark Lew
- Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA USA
| | - Diego Torres-Russotto
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
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de Bruijn TWP, Sohier J, van der Burg JJW. Outpatient Treatment Based on Self-Management Strategies for Chronic Drooling in Two Children. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2017; 29:735-755. [PMID: 28943744 PMCID: PMC5585278 DOI: 10.1007/s10882-017-9553-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Drooling is a distressing condition, which is often caused by reduced oral motor control associated with a neurological disorder. It has significant medical, practical and psychosocial impact on children or youth and their families. Therefore, treatment is necessary. Although behavioural therapy for drooling shows promising results, it is generally time- and cost-intensive. For this reason, alternative ways to provide behavioural treatment for chronic drooling need to be explored. In a pair of case studies, the feasibility and potential of an outpatient variant of a behavioural treatment programme for drooling based on self-management strategies was researched with two children with oral motor difficulties. In a three week programme, these children were taught to perform a self-management routine in order to achieve saliva control during regular visits to the child rehabilitation centre. In addition, their parents and teachers were taught to prompt the self-management routine and instructed to provide additional practice at home and at school. In doing so, they were offered support by means of telehealth and personal contact. At the end of the treatment programme, both children showed a significant decrease in drooling severity. Their parents and teachers were satisfied with the treatment effect. Although the present treatment programme showed promising results, further adaptions are necessary to make the treatment programme more widely accessible.
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Affiliation(s)
- Tessa W. P. de Bruijn
- Department of Pediatric Rehabilitation, Sint Maartenskliniek, Postbus 9011, 6500 GM Nijmegen, The Netherlands
| | - Jody Sohier
- Department of Pediatric Rehabilitation, Sint Maartenskliniek, Postbus 9011, 6500 GM Nijmegen, The Netherlands
| | - Jan J. W. van der Burg
- Department of Pediatric Rehabilitation, Sint Maartenskliniek, Postbus 9011, 6500 GM Nijmegen, The Netherlands
- Department of Pedagogical and Educational Sciences, Radboud University, Postbus 9104, 6500 HE Nijmegen, The Netherlands
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Mailly M, Rebours C, Koskas P, Klap P, Ayache D, Cohen M. [Interests of the ultrasound-guidance in the treatment of drooling through botulinum toxin injections, our experience over 10 years]. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017; 118:5-10. [PMID: 28330576 DOI: 10.1016/j.jormas.2016.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/18/2016] [Accepted: 12/05/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To report about our 10 years' experience about the treatment of drooling by ultrasound guided botulinum toxin injections. MATERIAL AND METHODS Retrospective monocentric study including all the patients suffering from drooling and treated by ultrasound-guided botulinum toxin injections into the salivary glands between 2004 and 2015. The etiology of r drooling, the doses of toxin, the injected glands, the size of the glands measured by ultrasonography, the effectiveness of the treatment and the side effects were assessed. RESULTS Two hundred and ninety-two injections sessions were performed in 61 patients. Exactly 70.5 % of patients reported an improvement after the first session. Parkinson's disease was the main etiology of drooling (43 % of the patients). Eleven patients reported side effects. The salivary gland volume reduced after treatment in 46 % of the patients. DISCUSSION The interest of ultrasound-guidance is to make sure about the intraglandular injection, to lower the risk for extraglandular diffusion of the toxin responsible for swallowing disorders and to allow for an adaptation of the doses to the volume of the salivary glands, which may vary during treatment.
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Affiliation(s)
- M Mailly
- Service d'ORL et de chirurgie de la face et du cou, Fondation Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France.
| | - C Rebours
- Service d'ORL et de chirurgie de la face et du cou, Fondation Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France
| | - P Koskas
- Service d'imagerie médicale, Fondation Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France
| | - P Klap
- Service d'ORL et de chirurgie de la face et du cou, Fondation Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France
| | - D Ayache
- Service d'ORL et de chirurgie de la face et du cou, Fondation Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France
| | - M Cohen
- Service d'ORL et de chirurgie de la face et du cou, Fondation Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France
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So JI, Song DH, Park JH, Choi E, Yoon JY, Yoo Y, Chung ME. Accuracy of Ultrasound-Guided and Non-ultrasound-Guided Botulinum Toxin Injection Into Cadaver Salivary Glands. Ann Rehabil Med 2017; 41:51-57. [PMID: 28289635 PMCID: PMC5344826 DOI: 10.5535/arm.2017.41.1.51] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/20/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the accuracy of ultrasound (US)-guided and non-US-guided botulinum toxin (BTX) injection into the salivary glands (parotid and submandibular glands) of cadavers. METHODS Two rehabilitation physician injected dye into three sites in the salivary glands (two sites in the parotid gland and one site in the submandibular gland) on one side of each cadaver (one was injected on the right side, while the other was injected on the left side), using either a non-US-guided injection procedure based on superficial landmarks or a US-guided procedure. Orange dye was used for the US-guided procedure, and green dye was used for the blind procedure. Two physicians uninvolved with the injection procedures and who were blinded to the method of injection dissected the cadavers to identify whether the dye was accurately injected into each target site. RESULTS The accuracies of the blind and US-guided injections into the parotid gland were 79.17% and 95.83%, respectively. In the submandibular gland, the accuracies of the blind and US-guided injections were 50.00% and 91.67%, respectively. The difference in accuracy between the two procedures was statistically significant only in the submandibular gland (p=0.025). There were no significant differences in the accuracy of US-guided and non-US-guided injections between the two physicians for the two sites in the parotid gland (p=0.278 and p=0.146, respectively). CONCLUSION US-guided BTX injection into the submandibular gland offers significantly greater accuracy over blind injection. For the treatment of drooling by injecting BTX into the submandibular gland, clinicians should consider using US guidance for improved accuracy.
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Affiliation(s)
- Jae In So
- Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dae Heon Song
- Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joo Hyun Park
- Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eunseok Choi
- Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Yoon Yoon
- Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeonji Yoo
- Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung Eun Chung
- Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Norderyd J, Graf J, Marcusson A, Nilsson K, Sjöstrand E, Steinwall G, Ärleskog E, Bågesund M. Sublingual administration of atropine eyedrops in children with excessive drooling - a pilot study. Int J Paediatr Dent 2017; 27:22-29. [PMID: 26708211 PMCID: PMC5324542 DOI: 10.1111/ipd.12219] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Drooling can be a severe disability and have high impact on daily life. Reversible treatment is preferable. AIM To analyse whether sublingual administration of atropine eyedrops is a useful reversible treatment option for severe drooling in children with disabilities. DESIGN The study had a prospective, single-system research design. The participants served as their own controls. The study period was 3 weeks without treatment, 4 weeks with atropine eyedrop solution 10 mg/mL one drop a day followed by 4 weeks of one drop twice a day. Parents' rating of their child's drooling was assessed on a 100-mm VAS, and unstimulated salivary secretion rate measurement was performed together with notations about side effects and practicality. RESULTS Parents' VAS assessment of drooling decreased from a median (range) of 74 (40-98) at baseline to 48 (18-88) (P = 0.05) and 32 (12-85) (P = 0.004) after 4 weeks of atropine once a day and another 4 weeks of atropine twice a day, respectively (n = 11). Unstimulated salivary secretion rates decreased from baseline to end of study (P = 0.032). Several parents complained about difficult administration. No irreversible side effects were noted. CONCLUSIONS Sublingual atropine eyedrops may be an alternative for treatment of severe drooling in children with disabilities.
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Affiliation(s)
- Johanna Norderyd
- National Oral Disability Centre for Rare DisordersThe Institute for Postgraduate Dental EducationJönköpingSweden,CHILD, Swedish Institute for Disability ResearchJönköping UniversityJönköpingSweden
| | - Jonas Graf
- Department of Otorhinolaryngology and Department of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden
| | - Agneta Marcusson
- Department of Dentofacial OrthopedicsMaxillofacial UnitLinköping UniversityLinköpingSweden
| | | | - Eva Sjöstrand
- Department for Child and Youth HabilitationCounty Council of ÖstergötlandLinköpingSweden
| | | | - Elinor Ärleskog
- Department of Oral & Maxillofacial SurgeryLinköping University HospitalLinköpingSweden
| | - Mats Bågesund
- Centre for Orthodontics and Paediatric Dentistry and Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
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Abstract
Cerebral palsy (CP) is a common chronic motor disorder with associated cognitive, communicative, and seizure disorders. Children with CP have a higher risk of dental problems creating significant morbidity that can further affect their wellbeing and negatively impact their quality of life. Screening for dental disease should be part of the initial assessment of any child with CP. The objective of this article is to present an updated overview of dental health issues in children with CP and outline important preventative and practical strategies to the management of this common comorbidity. Providing adequate oral care requires adaptation of special dental skills to help families manage the ongoing health issues that may arise. As oral health is increasingly recognized as a foundation for general wellbeing, caregivers for CP patients should be considered an important component of the oral health team and must become knowledgeable and competent in home oral health practices.
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Affiliation(s)
- Basil M Jan
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
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Abstract
Many children with mental retardation and developmental disabilities suffer from the consequences of chronic drooling. Behavioral treatment for drooling should be considered before other, more intrusive treatments such as medication and surgery are implemented. However, empirical studies on behavioral procedures are scarce. This article reviews 19 behavioral studies published since 1970. Treatment procedures are (a) instruction, prompting, and positive reinforcement; (b) negative social reinforcement and declarative procedures; (c) cueing techniques; and (d) self-management procedures. Although these procedures yield positive results, critical examination of experimental methodology of the studies reveals several methodological shortcomings. Guidelines for clinical use of behavioral treatment for drooling are presented, and recommendations are given for future research in this area.
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Chaléat-Valayer E, Porte M, Buchet-Poyau K, Roumenoff-Turcant F, D'Anjou MC, Boulay C, Bernard JC, Touzet S. Management of drooling in children with cerebral palsy: A French survey. Eur J Paediatr Neurol 2016; 20:524-31. [PMID: 27155820 DOI: 10.1016/j.ejpn.2016.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 03/29/2016] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
Abstract
AIM To characterise children with cerebral palsy (CP) and pathological drooling in France, and to describe care pathways, assessment and treatment. METHOD A transversal, observational, descriptive survey of the practices and opinions of 400 health professionals potentially involved in the care of children with CP, was carried out nationally across France in 2013. RESULTS The response rate was 36%. Seventy-five questionnaires were returned and analysed (52%). A small proportion of children were specifically treated for drooling (<25%). Assessments were carried out in 75% of cases and 91% of professionals prescribed treatments. Use of assessment tools varied widely. The most common treatment was oro-facial rehabilitation (95% of professionals), followed by anticholinergic drugs (Scopolamine(®)) (94%) botulinum toxin injections (BT) (66%) and surgery (34%). Scopolamine was considered to be less effective than BT and to have more side effects. CONCLUSION The rate of pathological drooling in children with CP is likely underestimated and under treated in France. There is a lack of knowledge regarding assessment tools. Aside from rehabilitation, current practice is to prescribe medication as the first-line treatment, however professionals consider that BT is more effective and has less side effects.
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Affiliation(s)
- E Chaléat-Valayer
- Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, 69322 Lyon Cedex 05, France.
| | - M Porte
- Centre Hospitalier Universitaire de Nîmes, 30029, France.
| | - K Buchet-Poyau
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon F-69003, France.
| | - F Roumenoff-Turcant
- Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, 69322 Lyon Cedex 05, France.
| | - M C D'Anjou
- Coordination SSR Pédiatrique Hôpital Nord, Saint Etienne 42055, France.
| | - C Boulay
- Service de Neurologie Pédiatrique, CHU Timone Enfants, 13385 Marseille, France.
| | - J C Bernard
- Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, 69322 Lyon Cedex 05, France.
| | - S Touzet
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon F-69003, France; Universite de Lyon, EA 7425 Health Services and Performance Research (HESPER), Lyon F-69008, France.
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Collares EF, Fernandes MIM. The ontogeny of saliva secretion in infants and esophagoprotection. ARQUIVOS DE GASTROENTEROLOGIA 2016; 52:156-60. [PMID: 26039837 DOI: 10.1590/s0004-28032015000200016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/18/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Several studies have reported that severe reflux esophagitis is rare in infants despite the well known high occurrence of regurgitation in early infancy. There is evidence of the importance of saliva for the pre-epithelial protection of the esophageal mucosa. RESULTS A longitudinal study conducted on healthy infants indicated that the stimulated capacity of saliva secretion (saliva output per kg of body weight) was significantly higher during their first year of age compared to older children and adults. In addition, this secretion pattern was also observed in low weight newborns during the first weeks of life and persisted in infants with severe protein-calorie malnutrition (marasmus). CONCLUSION The greater ability to secrete saliva is an important physiological condition that may protect the infant from acid/pepsin aggression to the esophagus during early stages of development.
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Affiliation(s)
- Edgard Ferro Collares
- Department of Pediatrics, Faculty of Medical Sciences, University of Campinas-UNICAMP, Campinas, SP, Brazil
| | - Maria Inez Machado Fernandes
- Department of Puericulture and Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo-USP, Ribeirão Preto, SP, Brazil
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Initial experience from a multidisciplinary pediatric salivary gland disorder clinic. Int J Pediatr Otorhinolaryngol 2015; 79:1505-9. [PMID: 26231740 DOI: 10.1016/j.ijporl.2015.06.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study is the first in the literature to characterize and detail the clinical and surgical experience of one of the few multidisciplinary salivary gland disorder clinics in North America. METHODS This is a retrospective chart review of a descriptive nature, including patient information from February 2013 to August 2014. The Salivary Gland Disorder Clinic (SGDC) is located at Nationwide Children's Hospital, a public academic hospital. All patients seen at the SGDC were included in this study, 54 in total. Patients were seen for any salivary gland disorder presentation, ranging from sialorrhea to glandular masses. RESULTS A total of 70.4% of patients presented to the SGDC with a chief complaint of sialorrhea. Nearly 28% had previously experienced documented aspiration, and drooling severity and frequency was 4.06 and 3.3 on the Thomas-Stonell and Greenberg Drooling Rating Scales. 50% of patients presented with neurologic comorbidities and 25.9% with aerodigestive tract anatomic defects. Over 35% of patients had previously attempted medical treatment and 31.5% had no prior treatment attempts. 87% of all patients were offered further treatment options, including interventional, surgical, medical, and conservative measures. CONCLUSIONS Pediatric salivary gland disorders, especially sialorrhea, can profoundly impact overall health and quality of life. Appropriate management of this symptom requires expert training and knowledge of the upper aerodigestive tract anatomy and appropriate treatment modalities. Our study demonstrates that there is community need for a centralized salivary gland disorder clinic given the complex comorbidities and social challenges that face this population. Many patients present with great risk for aspiration-related complications and the vast majority are offered new treatment options.
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Hawkey NM, Zaorsky NG, Galloway TJ. The role of radiation therapy in the management of sialorrhea: A systematic review. Laryngoscope 2015; 126:80-5. [PMID: 26152655 DOI: 10.1002/lary.25444] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE Up to 80% of patients with Parkinson disease and 30% of patients with amyotrophic lateral sclerosis (ALS) suffer from sialorrhea. Patients who fail medical and surgical therapy should be considered for external beam radiation therapy (EBRT). In this study, we conduct a systematic review to determine the dose and techniques used that result in greatest efficacy and lowest toxicity for the administration of EBRT in patients with Parkinson disease or ALS-associated sialorrhea. METHODS AND MATERIALS This review included 216 patients from four prospective and six retrospective studies published from 1998 to 2014, with ALS or Parkinson disease who were treated with electron or photon EBRT for sialorrhea. RESULTS A total of 216 patients were treated with EBRT from 10 studies. The indication for EBRT was failure of alternative medical treatment in all ALS patients. For patients with Parkinson disease, EBRT was the primary mode of treatment in 68% of cases. Overall, 176 (81%) of 216 patients treated with EBRT for sialorrhea reported symptomatic improvement from baseline. The most common target was the inferior two-thirds of the bilateral parotid glands and the entire bilateral submandibular glands. The total number of patients who experienced short-term toxicity was 86 of 216 patients (40%). The total number of patients who experienced long-term toxicity was 24 of 207 (12%). CONCLUSIONS EBRT is an effective treatment for sialorrhea in patients suffering from ALS or Parkinson disease. Treatment to the bilateral submandibular glands and caudal parotid glands is the most common field arrangement.
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Affiliation(s)
- Nathan M Hawkey
- Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, U.S.A
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, U.S.A
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Slade A, Stanic S. Managing excessive saliva with salivary gland irradiation in patients with amyotrophic lateral sclerosis. J Neurol Sci 2015; 352:34-6. [PMID: 25881952 DOI: 10.1016/j.jns.2015.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/12/2015] [Accepted: 02/04/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE A significant fraction of patients with amyotrophic lateral sclerosis (ALS) are unable to swallow saliva, which may result in the spillage of saliva outside of the oral cavity. Although anticholinergic agents and botulin toxin injections are considered the first line of treatment, they have not been effective for all patients. We performed a literature search on therapeutic salivary gland irradiation in patients with ALS. METHODS We searched the PubMed for English language publications up to December 2014 on therapeutic salivary gland irradiation in patients with ALS. The search was performed using the following key words: amyotrophic lateral sclerosis, excessive salivation, sialorrhea, and radiation therapy. RESULTS The majority of ALS patients with excessive salivation respond well to salivary gland irradiation. The whole bilateral submandibular, and whole or partial bilateral parotid glands have been the target tissue for radiation therapy in most of the published studies. Various radiation therapy regimens have been utilized. The response to radiation therapy lasts for several months. CONCLUSIONS The majority of ALS patients with excessive salivation respond well to salivary gland irradiation. Neurologists should consider this treatment option for select patients with ALS and excessive salivation.
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Affiliation(s)
- Alexander Slade
- Department of Radiation Oncology at Carle Cancer Center, University of Illinois College of Medicine at Urbana-Champaign, Urbana, IL, USA
| | - Sinisa Stanic
- Department of Radiation Oncology at Carle Cancer Center, University of Illinois College of Medicine at Urbana-Champaign, Urbana, IL, USA.
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Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, Farré M. Salivary Secretory Disorders, Inducing Drugs, and Clinical Management. Int J Med Sci 2015; 12:811-24. [PMID: 26516310 PMCID: PMC4615242 DOI: 10.7150/ijms.12912] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/02/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Salivary secretory disorders can be the result of a wide range of factors. Their prevalence and negative effects on the patient's quality of life oblige the clinician to confront the issue. AIM To review the salivary secretory disorders, inducing drugs and their clinical management. METHODS In this article, a literature search of these dysfunctions was conducted with the assistance of a research librarian in the MEDLINE/PubMed Database. RESULTS Xerostomia, or dry mouth syndrome, can be caused by medication, systemic diseases such as Sjögren's Syndrome, glandular pathologies, and radiotherapy of the head and neck. Treatment of dry mouth is aimed at both minimizing its symptoms and preventing oral complications with the employment of sialogogues and topical acting substances. Sialorrhea and drooling, are mainly due to medication or neurological systemic disease. There are various therapeutic, pharmacologic, and surgical alternatives for its management. The pharmacology of most of the substances employed for the treatment of salivary disorders is well-known. Nevertheless, in some cases a significant improvement in salivary function has not been observed after their administration. CONCLUSION At present, there are numerous frequently prescribed drugs whose unwanted effects include some kind of salivary disorder. In addition, the differing pathologic mechanisms, and the great variety of existing treatments hinder the clinical management of these patients. The authors have designed an algorithm to facilitate the decision making process when physicians, oral surgeons, or dentists face these salivary dysfunctions.
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Affiliation(s)
- Jaume Miranda-Rius
- 1. Departament d'Odontostomatologia. Facultat d'Odontologia. Universitat de Barcelona, Barcelona, Spain
| | - Lluís Brunet-Llobet
- 2. Servei d'Odontologia. Hospital Sant Joan de Déu. Universitat de Barcelona, Barcelona, Spain
| | - Eduard Lahor-Soler
- 1. Departament d'Odontostomatologia. Facultat d'Odontologia. Universitat de Barcelona, Barcelona, Spain
| | - Magí Farré
- 3. Clinical Pharmacology Unit. Hospital Universitari Germans Trias i Pujol-IGTP and Hospital del Mar Medical Research Institute (IMIM). Facultat de Medicina. Universitat Autònoma de Barcelona, Barcelona, Spain
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