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Rajanala S, Salame N, Dover JS. Using Neuromodulators for Salivary, Eccrine, and Apocrine Gland Disorders. Dermatol Surg 2024; 50:S103-S111. [PMID: 39196843 DOI: 10.1097/dss.0000000000004262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
BACKGROUND Sialorrhea, hyperhidrosis, bromhidrosis, and chromhidrosis are common glandular disorders that substantially impact patients' health and quality of life. Botulinum toxin can safely and temporarily decrease gland secretions by targeting the parasympathetic cholinergic neurons, resulting in diminished saliva and sweat production. OBJECTIVE The objective of this article is to describe the applications of neuromodulators for the treatment of salivary, eccrine, and apocrine glands. METHODS PubMed was searched from inception to February 1, 2024 using search terms "neurotoxin," "botulinum toxin," "sialorrhea," "hyperhidrosis," "bromhidrosis," and "chromhidrosis." RESULTS Incobotulinumtoxin A and Rimabotulinumtoxin B are approved by the FDA for the treatment of sialorrhea. Onabotulinumtoxin A is the only FDA-approved botulinum toxin for axillary hyperhidrosis and is used off-label for hyperhidrosis of nonaxillary sites, bromhidrosis, and chromhidrosis. Compared to botulinum toxin serotype A, serotype B has been associated with more immunogenicity, which may have implications for patients requiring long-term treatment for chronic glandular disorders. CONCLUSION Neuromodulators are safe and effective for the noninvasive treatment of excess gland activity and can improve patients' quality of life. While substantial literature supports botulinum toxin treatments for hyperhidrosis, further studies are needed to characterize standard dosing and administration techniques for sialorrhea, bromhidrosis, and chromhidrosis.
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Affiliation(s)
- Susruthi Rajanala
- Department of Dermatology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | | | - Jeffrey S Dover
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
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Kronlage RM, Fadil AB, Drew KL, Smith IB, Collins WO, Schrepfer T. Navigating the spectrum of pediatric sialorrhea management: A narrative review. Am J Otolaryngol 2024; 45:104433. [PMID: 39067093 DOI: 10.1016/j.amjoto.2024.104433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE This review summarizes the approaches to pediatric sialorrhea management from least-to-most invasive: non-pharmacological management, anticholinergic medications, botulinum neurotoxin, non-invasive surgery, and invasive surgical intervention. REVIEW METHODS An electronic literature review identified English-language articles on sialorrhea management in pediatric patients. Publications between 1982 and 2022 were used, with a focus on articles published from 2012 to 2022. Additional augmentation of pharmacologic information was obtained from the latest editions of medical textbooks supplemented with official package inserts of investigated medications. CONCLUSIONS Sialorrhea is abnormal in patients greater than four years of age. Severe cases warrant intervention to improve patient quality of life and reduce caregiver burden. Management starts with conservative approaches. Viable candidates begin with non-pharmacological management options. Anticholinergic medications can decrease saliva production, but adverse side effects may outweigh benefits. Botulinum neurotoxin injection of the salivary glands decreases salivary flow rate; however, relief is transient and thus multiple treatments are required. Non-invasive sclerotherapy is an emerging treatment option showing promising results for sialorrhea. In contrast, surgical intervention is reserved as a last-resort treatment for patients with severe symptoms, due to its higher risk for adverse consequences. IMPLICATIONS FOR PRACTICE Physicians should be familiar with the different pediatric sialorrhea management options, including advantages and disadvantages, to adequately facilitate shared decision making with caretakers of pediatric patients who require treatment.
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Affiliation(s)
- René M Kronlage
- University of Florida College of Medicine, Gainesville, FL, USA.
| | - Angela B Fadil
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Kristin L Drew
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Isaac B Smith
- University of Florida College of Medicine, Gainesville, FL, USA
| | - William O Collins
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Thomas Schrepfer
- Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Florida College of Medicine, Gainesville, FL, USA
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Hast MA, Kong AM, Abdelhadi J, Shah R, Szendrey A, Holmes J. Real-World Observational Analysis of Clinical Characteristics and Treatment Patterns of Patients with Chronic Sialorrhea. Toxins (Basel) 2024; 16:366. [PMID: 39195776 PMCID: PMC11360601 DOI: 10.3390/toxins16080366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/06/2024] [Accepted: 08/16/2024] [Indexed: 08/29/2024] Open
Abstract
Chronic sialorrhea is a condition characterized by excessive drooling, often associated with neurological and neuromuscular disorders such as Parkinson's disease, cerebral palsy, and stroke. Despite its prevalence, it remains underdiagnosed and poorly understood, leading to a lack of comprehensive data on patient demographics, clinical characteristics, and treatment patterns. This study aimed to help fill these existing gaps by analyzing real-world data using Optum's de-identified Clinformatics® Data Mart Database. Patients were required to have a diagnosis indicative of sialorrhea plus evidence of sialorrhea treatment between 1/1/2007 and 5/31/2022. Two cohorts were analyzed: patients with evidence of newly diagnosed sialorrhea and associated treatment, and sialorrhea patients initiating incobotulinumtoxinA. Clinical characteristics, comorbidities, symptoms, and treatment utilization were described before and after diagnosis and incobotulinumtoxinA initiation. No formal statistical comparisons were performed. Patients were predominantly aged 65 or older, male, and non-Hispanic white. Parkinson's disease and cerebral palsy were the most common comorbidities among adults and children, respectively. Treatment patterns suggest that anticholinergics are more commonly used than botulinum toxin therapy. The findings offer valuable information for improving diagnosis and treatment approaches and suggest a need for further research into treatment effectiveness, safety, and disease burden.
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Affiliation(s)
| | - Amanda M. Kong
- Aetion, New York, NY 10001, USA; (A.M.K.); (J.A.); (R.S.); (A.S.)
| | - Jenna Abdelhadi
- Aetion, New York, NY 10001, USA; (A.M.K.); (J.A.); (R.S.); (A.S.)
| | - Rohan Shah
- Aetion, New York, NY 10001, USA; (A.M.K.); (J.A.); (R.S.); (A.S.)
| | - Andrew Szendrey
- Aetion, New York, NY 10001, USA; (A.M.K.); (J.A.); (R.S.); (A.S.)
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He Z, Chen S, Zeng P, Dai M, Wei X, Chen J, Zhang X, Dou Z, Wen H, Li C. The effectiveness of ultrasound-guided injection of BTX-A in the management of sialorrhea in neurogenic dysphagia patients. Laryngoscope Investig Otolaryngol 2023; 8:1607-1615. [PMID: 38130251 PMCID: PMC10731496 DOI: 10.1002/lio2.1164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/08/2023] [Indexed: 12/23/2023] Open
Abstract
Objective To evaluate the effectiveness of ultrasound-guided injection of botulinum toxin type A (BTX-A) in treating sialorrhea. Methods We recruited 32 sialorrhea subjects and they received an ultrasound-guided injection of BTX-A. The extent of salivation was evaluated according to the Visual Analog Scale (VAS), Drooling Severity and Frequency Scale (DSFS), and Saliva Flow Rate (SFR). Laryngeal secretions were evaluated based on Fiberoptic Endoscopic Evaluation of Swallowing (FEES) rated according to the Murray Secretion Scale (MSS). We assessed the extent of salivation and laryngeal secretions before injection and at 1, 2, and 4 weeks after injection. Results The scores for the VAS, DSFS-S, DSFS-F, and DSFS-T decreased significantly at 1, 2, and 4 weeks after injection compared with before injection (p < .05). Based on VAS, the efficacy was substantially higher at 2 and 4 weeks after injection than at 1 week after injection (p < .05). According to DSFS-S and DSFS-T, the efficacy was significantly higher at 4 weeks than at 1 week after injection (p < .05). The SFR and MSS scores at 1 and 2 weeks after injection were superior to those before injection (p < .05). Meanwhile, the SFR score 2 weeks after injection was superior to that 1 week after injection (p < .05). Conclusion The ultrasound-guided injection of BTX-A can effectively reduce saliva secretion in patients with neurogenic dysphagia. Furthermore, it has the advantages of early onset time and lasting curative effects, which indicates that clinical promotion and application of this technique are justified. Level of Evidence Level 3.
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Affiliation(s)
- Zitong He
- Department of Rehabilitation Medicine, The Third Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Suling Chen
- Department of Rehabilitation Medicine, The Third Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Peishan Zeng
- Department of Rehabilitation Medicine, The Third Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Meng Dai
- Department of Rehabilitation Medicine, The Third Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Xiaomei Wei
- Department of Rehabilitation Medicine, The Third Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Jiemei Chen
- Department of Rehabilitation Medicine, The Third Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Xue Zhang
- Department of Rehabilitation Medicine, The Third Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Hongmei Wen
- Department of Rehabilitation Medicine, The Third Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Chao Li
- Department of Rehabilitation Medicine, The Third Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
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Santos Junior LC, Santos JR, Reis A, Faria-E-Silva AL, Leal PC. Effectiveness of the pharmacological treatments for sialorrhea in patients with Parkinson's disease: a systematic review and network meta-analysis. Clin Oral Investig 2023:10.1007/s00784-023-04981-9. [PMID: 37036514 DOI: 10.1007/s00784-023-04981-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 03/28/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVES The present systematic review and network meta-analysis of randomized control trials (RCTs) aimed to establish whether there are evidence-based differences in the pharmacological agents used to manage sialorrhea in patients with Parkinson's disease (PD). MATERIAL AND METHODS The authors searched the databases: MEDLINE via PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library for clinical trials. Unpublished trials were searched on clinicaltrials.gov and the Brazilian Clinical Trials Registry. Means and standard deviations of changes in the salivary flow or drooling reported by participants due to the interventions were recorded. RESULTS The authors analyzed 13 RCTs. Compared to the placebo, types A and B of the botulinum toxin effectively reduced the salivary flow and the severity or frequency of drooling. However, the network meta-analysis did not differentiate between the botulinum toxin types. Ipratropium bromide and glycopyrrolate did not differ from the placebo. Indirect evidence showed that ipratropium had similar results to those obtained with both types of botulinum toxin. The CINeMA approach estimated the quality of the evidence as very low for all comparisons. CONCLUSION The best treatment for sialorrhea in patients with PD is not fully elucidated yet. Therefore, more well-conducted randomized clinical trials are required to increase the level of evidence. CLINICAL RELEVANCE There needs to be more evidence defining the best intervention to treat sialorrhea in patients with PD. However, botulinum toxin types A and B seem to reduce sialorrhea in patients effectively.
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Affiliation(s)
- Luiz Carlos Santos Junior
- Graduate Program in Dentistry, Federal University of Sergipe, Rua Cláudio Batista, S/N, Sanatório, Aracaju, SE, 49.060-108, Brazil
| | - José Ronaldo Santos
- Behavioral and Evolutionary Neurobiology Laboratory, Department of Biosciences, Federal University of Sergipe, Av. Vereador Olímpio Grande, S/N, Itabaiana, SE, 49506-036, Brazil
| | - Alessandra Reis
- Department of Restorative Dentistry, State University of Ponta Grossa, Avenida Carlos Cavalcanti, 4748, Bloco M, Sala 04, Ponta Grossa, PR, 84030-900, Brazil
| | - André Luís Faria-E-Silva
- Graduate Program in Dentistry, Federal University of Sergipe, Rua Cláudio Batista, S/N, Sanatório, Aracaju, SE, 49.060-108, Brazil
| | - Pollyana Caldeira Leal
- Graduate Program in Dentistry, Federal University of Sergipe, Rua Cláudio Batista, S/N, Sanatório, Aracaju, SE, 49.060-108, Brazil.
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Jost WH, Bäumer T, Bevot A, Birkmann U, Buhmann C, Grosheva M, Guntinas-Lichius O, Mlynczak U, Paus S, Pflug C, Schröder S, Steffen A, Wilken B, Berweck S. [Treatment of Sialorrhea with Botulinum Neurotoxin Type A - Consensus Practice Recommendations for Children and Adults]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022; 90:212-221. [PMID: 35453158 PMCID: PMC9113851 DOI: 10.1055/a-1802-6006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Sialorrhea, uncontrolled, excessive drooling, accompanies different, mostly neurological disorders from childhood to adulthood. With incobotulinumtoxinA (Xeomin, IncoBoNT/A, Merz Pharmaceuticals GmbH), an approved medication for the treatment of sialorrhea has been available since 2019. Patient selection, possible therapy goals, treatment and the management of specific treatment situations build the focus of this interdisciplinary expert consensus recommendations with the intent to facilitate access to treatment and to contribute to qualified botulinum toxin therapy.
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Affiliation(s)
| | - Tobias Bäumer
- Institut für Systemische Motorikforschung, CBBM; Sektion Zentrum für Seltene Erkrankungen, Universität zu Lübeck/Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Andrea Bevot
- Neuropädiatrie, Entwicklungsneurologie, Sozialpädiatrie, Universitätsklinik für Kinder und Jugendmedizin, Tübingen, Germany
| | | | - Carsten Buhmann
- Neurologie, Universitatsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Grosheva
- Klinik für Neurologie und Ambulanzzentrum Bereich Neurologie, Universitätsklinikum Eppendorf, Hamburg, Germany
| | | | - Ute Mlynczak
- UniReha GmbH, Klinik und Poliklinik für HNO-Heilkunde, Kopf- und Halschirurgie, Uniklinik Köln, Köln, Germany
| | - Sebastian Paus
- Fachabteilung Neurologie, GFO Kliniken Troisdorf, Troisdorf, Germany
| | - Christina Pflug
- Klinik und Poliklinik für Hör-, Stimm- und Sprachheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Schröder
- Pädiatrische Neurologie, Entwicklungsneurologie, iSPZ, Dr. von Haunersches Kinderspital, Klinikum der Universität München, München, Germany
| | - Armin Steffen
- Klinik für HNO-Heilkunde, Universität zu Lübeck/UKSH Campus Lübeck, Lübeck, Germany
| | - Bernd Wilken
- Neuropädiatrie mit Sozialpädiatrischem Zentrum, Klinikum Kassel, Kassel, Germany
| | - Steffen Berweck
- Fachzentrum für Pädiatrische Neurologie, Neurorehabilitation und Epileptologie, Schön Klinik, Vogtareuth, Vogtareuth, Germany
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