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Wijdicks EFM, Ropper AH. Neuroleptic Malignant Syndrome. N Engl J Med 2024; 391:1130-1138. [PMID: 39321364 DOI: 10.1056/nejmra2404606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Affiliation(s)
- Eelco F M Wijdicks
- From the Neurosciences Intensive Care Unit, Mayo Clinic Hospital, Rochester, MN (E.F.M.W.)
| | - Allan H Ropper
- From the Neurosciences Intensive Care Unit, Mayo Clinic Hospital, Rochester, MN (E.F.M.W.)
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2
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Crisafulli S, Ciccimarra F, Khan Z, Maccarrone F, Trifirò G. Understanding Clinical Effectiveness and Safety Implications of Botulinum Toxin in Children: A Narrative Review of the Literature. Toxins (Basel) 2024; 16:306. [PMID: 39057946 PMCID: PMC11281390 DOI: 10.3390/toxins16070306] [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: 04/29/2024] [Revised: 06/20/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
Since its first approval by the Food and Drug Administration in 1989 for strabismus, botulinum toxin indications of use have been widely expanded. Due to its anticholinergic properties, this toxin is currently approved in adult patients for the treatment of a wide range of neuromuscular, otolaryngologic, orthopedic, gastrointestinal, and urologic disorders. Approved pediatric indications of use include the treatment of blepharospasm associated with dystonia, strabismus, lower-limb spasticity, focal spasticity in patients with cerebral palsy, and neurogenic detrusor overactivity. Alongside these approved indications, botulinum toxin is extensively used off-label. Although several clinical studies have shown that botulinum toxin is effective and well-tolerated in children, uncertainties persist regarding its long-term effects on growth and appropriate dosing in this population. As such, further research is needed to better define the botulinum toxin risk-benefit profile and expand approved uses in pediatrics. This narrative review aimed to provide a broad overview of the evidence concerning the clinical effectiveness and safety of BoNT with respect to its principal authorized and non-authorized pediatric therapeutic indications, as well as to describe perspectives on its future use in children.
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Affiliation(s)
| | - Francesco Ciccimarra
- Department of Diagnostics and Public Health, University of Verona, 37124 Verona, Italy; (F.C.); (F.M.)
| | - Zakir Khan
- Department of Pharmacy Practice, Riphah Institute of Pharmaceutical Sciences, Riphah International University, Gulberg Green Campus, Islamabad 44000, Pakistan;
| | - Francesco Maccarrone
- Department of Diagnostics and Public Health, University of Verona, 37124 Verona, Italy; (F.C.); (F.M.)
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, 37124 Verona, Italy; (F.C.); (F.M.)
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3
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Wang JJ, Shao MM, Zhou XZ, Lin ZC, Li HY, Yuan ZZ, Ma QQ, Li F, Fu WB. Intraoral Acupuncture for Sialorrhea in Stroke Patients: a Study Protocol for a Randomized Controlled Trial. J Acupunct Meridian Stud 2024; 17:100-109. [PMID: 38898647 DOI: 10.51507/j.jams.2024.17.3.100] [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: 01/09/2024] [Revised: 02/27/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Importance Post-stroke sialorrhea (PSS) refers to excessive saliva flowing out the lip border after a stroke. PSS negatively affects patient self-image and social communication and may lead to depression. Limited evidence supports the link between excessive salivation and PSS. No large-scale, strictly controlled randomized controlled trials have shown the effectiveness of acupuncture in treating PSS patients. Objective We aim to compare the effects of intraoral and sham acupuncture in PSS patients and explore relationships among salivation and drooling severity and frequency and swallowing function in stroke patients. Design Clinical study protocol, SPIRIT compliant. Setting Prospective, single-center, randomized, and sham-controlled trial. Population We will recruit 106 PSS patients to receive 4-week intraoral or sham acupuncture. Additionally, 53 stroke patients without PSS will undergo a conventional 4-week treatment program to compare salivation between PSS and non-PSS patients. Exposures Intraoral or sham acupuncture. Main Outcomes and Measures The main evaluation index will be the 3-minute saliva weight (3MSW), comparing changes in 3MSW from baseline to weeks 4 and 8. Secondary assessment indices will include the “Drooling Severity and Frequency Scale” and “Functional Oral Intake Scale.” Results The results from this study will be published in peer-reviewed journals. Conclusion Comparing effects of intraoral and sham acupuncture in PSS patients, this study may contribute important evidence for future PSS treatment and provide valuable insights into whether salivation issues in stroke patients are attributed to heightened salivary secretion or dysphagia.
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Affiliation(s)
- Jin-Jin Wang
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Meng-Meng Shao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xue-Zhen Zhou
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zu-Chen Lin
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hai-Yan Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zheng-Zhong Yuan
- Department of TCM, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qin-Qin Ma
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fang Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wen-Bin Fu
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Acupuncture and Moxibustion, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
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4
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Hobson E, McDermott C. Advances in symptom management and in monitoring disease progression in motor neuron disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 176:119-169. [PMID: 38802174 DOI: 10.1016/bs.irn.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
The aim of supportive management of motor neuron disease is to improve survival, promote good quality of life and patient independence and autonomy whilst preparing for future progression and the end of life. Multidisciplinary specialist care aims to address the multifaceted and interacting biopsychosocial problems associated with motor neuron disease that leads to proven benefits in both survival and quality of life. This chapter will explore principles, structure and details of treatment options, and make recommendations for practice and for future research.
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Affiliation(s)
- Esther Hobson
- Sheffield Institute for Translational Neuroscience, Division of Neuroscience, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| | - Christopher McDermott
- Sheffield Institute for Translational Neuroscience, Division of Neuroscience, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom.
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5
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Bhat A, Dean J, Aboussouan LS. Perioperative Management in Neuromuscular Diseases: A Narrative Review. J Clin Med 2024; 13:2963. [PMID: 38792504 PMCID: PMC11122304 DOI: 10.3390/jcm13102963] [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: 03/31/2024] [Revised: 05/04/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Patients with neuromuscular diseases are particularly vulnerable in the perioperative period to the development of pulmonary and cardiac complications, or medication side effects. These risks could include hypoventilation, aspiration pneumonia, exacerbation of underlying cardiomyopathy, arrhythmias, adrenal insufficiency, prolonged neuromuscular blockade, issues related to thermoregulation, rhabdomyolysis, malignant hyperthermia, or prolonged mechanical ventilation. Interventions at each of the perioperative stages can be implemented to mitigate these risks. A careful pre-operative evaluation may help identify risk factors so that appropriate interventions are initiated, including cardiology consultation, pulmonary function tests, initiation of noninvasive ventilation, or implementation of preventive measures. Important intraoperative issues include positioning, airway and anesthetic management, and adequate ventilation. The postoperative period may require correction of electrolyte abnormalities, control of secretions with medications, manual or mechanical cough assistance, avoiding the risk of reintubation, judicious pain control, and appropriate medication management. The aim of this review is to increase awareness of the particular surgical challenges in this vulnerable population, and guide the clinician on the various evaluations and interventions that may result in a favorable surgical outcome.
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Affiliation(s)
| | | | - Loutfi S. Aboussouan
- Respiratory and Neurological Institutes, Cleveland Clinic, Cleveland, OH 44195, USA; (A.B.); (J.D.)
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6
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Camacho LO, Jahangiri L, Iseringhausen J, Goldstein GR. Parkinson's disease - The dentist's role as part of the healthcare team. J Prosthodont 2024. [PMID: 38689457 DOI: 10.1111/jopr.13862] [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: 01/11/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
Parkinson's disease is a neurodegenerative disease that results in patients exhibiting uncontrolled movements, changes in saliva production, and difficulty in swallowing and speech. Understanding the staging of the disease and the available therapies allows dentists to treat these patients safely and with compassion to meet their oral health care needs for an optimal quality of life. This appraisal discusses Parkinson's disease as it relates to clinically relevant facts to manage and treat the oral health care needs of these patients in the short and long term including general dental care recommendations. Important observations related to Parkinson's disease include disease causation,; stages, pharmacologic treatment, the effects on saliva, mastication, dysphagia, and aspiration pneumonia. Dental recommendations are made for the dentate, the partially edentulous, and the completely edentulous Parkinson's patients with a focus on late-stage concerns. Optimizing dental health will help maintain the quality of life as the disease progresses. In late stages of Parkinson's disease, dental treatment should focus on keeping the patient comfortable and out of pain. While benign neglect is an often-used term, compassionate therapy in the late stages of Parkinson's disease is a more compelling term for defining the patient's needs. Since dysphagia in Parkinson's patients has been underdiagnosed, neurologists must be aware of the important part that dentists play in the early diagnosis for these patients. Early referral to a dentist is vital to mitigate the unfortunate consequence of the need for extensive dental care in late-stage patients.
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Affiliation(s)
- Liliana Ortiz Camacho
- Department of Prosthodontics, New York University College of Dentistry, New York, New York, USA
| | - Leila Jahangiri
- Department of Prosthodontics, New York University College of Dentistry, New York, New York, USA
| | - Jenna Iseringhausen
- Department of Neurology and Movement Disorders, New York University Langone Health, New York, New York, USA
| | - Gary R Goldstein
- Department of Prosthodontics, New York University College of Dentistry, New York, New York, USA
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Jost WH, Bäumer T, Bevot A, Birkmann U, Buhmann C, Grosheva M, Guntinas-Lichius O, Laskawi R, Paus S, Pflug C, Schroeder AS, Spittau B, Steffen A, Wilken B, Winterholler M, Berweck S. Botulinum neurotoxin type A in the interdisciplinary treatment of sialorrhea in adults and children-update and practice recommendations. Front Neurol 2023; 14:1275807. [PMID: 38162447 PMCID: PMC10757066 DOI: 10.3389/fneur.2023.1275807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
Sialorrhea is defined as a chronic excessive flow of saliva from the mouth, often with adverse consequences for health and quality of life of patients. In addition to currently used non-drug treatment and systemic drugs, intraglandular Botulinum Neurotoxin A (BoNT/A) injections have been examined in case studies, controlled trials and clinical practice. Two pivotal Phase III trials recently led to market approval in the USA and EU for IncobotulinumtoxinA [Xeomin®, IncoBoNT/A, Clostridium botulinum neurotoxin type A (150 kD), free from complexing proteins, Merz Pharmaceuticals GmbH] for treatment of chronic sialorrhea in adults and pediatric patients. This review provides a multidisciplinary approach to discuss the current state of sialorrhea therapy as well as benefits and current limitations of BoNT/A injections. A consensus regarding treatment recommendations made available to physicians in Germany in 2022 has now been updated here for presentation to an international audience. This review provides a framework including a flow chart for patient selection, recommendations for dosing and the injection process, as well as a discussion of therapeutic goals, long-term benefits and safety aspects. This review is aimed at supporting physicians in developing multidisciplinary and individualized treatment approaches to achieve optimal benefits for patients.
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Affiliation(s)
| | - Tobias Bäumer
- Institute of Systemic Motor Science, CBBM, University of Lübeck, Lübeck, Germany
| | - Andrea Bevot
- Department of Neuropediatrics and Developmental Medicine, University Children’s Hospital Tübingen, Tübingen, Germany
| | - Ulrich Birkmann
- Department of Neurology, Schluckambulanz, GFO Clinics Troisdorf, Troisdorf, Germany
| | - Carsten Buhmann
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Grosheva
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | | | - Rainer Laskawi
- Department of Otorhinolaryngology, University Hospital Göttingen, Göttingen, Germany
| | - Sebastian Paus
- Department of Neurology, GFO Clinics Troisdorf, Troisdorf, Germany
| | - Christina Pflug
- Department of Voice, Speech and Hearing Disorders, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - A. Sebastian Schroeder
- Clinic for Child Neurology and Social Pediatrics, Child Center Maulbronn, Maulbronn, Germany
| | - Björn Spittau
- Anatomy and Cell Biology, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Armin Steffen
- Department for Otorhinolaryngology, University of Lübeck, Lübeck, Germany
| | - Bernd Wilken
- Department of Pediatric Neurology, Klinikum Kassel, Kassel, Germany
| | - Martin Winterholler
- Department of Neurology, Sana Hospital Rummelsberg, Nuremberg/Schwarzenbruck, Germany
| | - Steffen Berweck
- Specialist Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schön Clinic, Vogtareuth, Germany
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Yang CL, Huang JP, Tan YC, Wang TT, Zhang H, Qu Y. The effectiveness and safety of botulinum toxin injections for the treatment of sialorrhea with Parkinson's disease: a systematic review and meta-analysis. BMC Pharmacol Toxicol 2023; 24:52. [PMID: 37828600 PMCID: PMC10571401 DOI: 10.1186/s40360-023-00694-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Botulinum toxin (BoNT) injection is an important adjunctive method to treat sialorrhea. The purpose of this systematic review was to analyze the effect and safety of BoNT injections in the intervention of sialorrhea with Parkinson's disease (PD). METHODS We searched PubMed, Web Of Science (WOS), Scopus, Cochrane CENTRAL, and Embase from inception until April 2022. Randomized controlled trials or randomized crossover trials comparing BoNT with placebo in sialorrhea with PD were eligible. PRISMA guidelines were used to carry out the meta-analysis. The Drooling Severity Frequency Scale (DSFS) score and the number of adverse events (AEs) were the primary and secondary outcomes, respectively. Standardized mean differences (SMDs) and risk differences (RDs) are used to express continuous and categorical outcomes, respectively. Heterogeneity among these studies was evaluated using I2 tests. We used the GRADE tool to assess the certainty of evidence (COE). RESULTS Eight articles involving 259 patients compared BoNT injections with a placebo for PD with sialorrhea. This meta-analysis showed a significant reduction in DSFS scores between BoNT injections and placebo (SMD=-0.98; 95% CI, -1.27 to 0.70, p<0.001; COE: high). This meta-analysis showed a significant difference in AEs between BoNT injections and placebo (RD=0.15; 95% CI, 0.05 to 0.24, p=0.002; COE: low). CONCLUSIONS The pooled results suggest that BoNT injections have some effect on DSFS scores with sialorrhea caused by PD. There are also mild adverse events, which generally recover within a week or so. The results indicate that BoNT injection is one of the treatments for sialorrhea caused by PD, but we need to pay attention to adverse events. In addition, the follow-up time was extended to observe oral hygiene, ulceration or dental caries, and digestive function. TRIAL REGISTRATION Our review protocol was registered on PROSPERO (42021288334).
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Affiliation(s)
- Chun-Lan Yang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
- Minda Hospital of Hubei Minzu University, Enshi, Hubei, 445000, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Jia-Peng Huang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Ying-Chao Tan
- Enshi Prefecture Central Hospital, Enshi, Hubei, 445000, PR China
| | - Ting-Ting Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Han Zhang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Yun Qu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China.
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China.
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Bergmans B, Clark V, Isaacson SH, Bäumer T. Recommendations for a paradigm shift in approach to increase the recognition and treatment of sialorrhea in Parkinson's disease. Clin Park Relat Disord 2023; 9:100223. [PMID: 38021341 PMCID: PMC10643485 DOI: 10.1016/j.prdoa.2023.100223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/29/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Sialorrhea, or drooling, is defined as excessive saliva accumulation and unwanted loss of saliva from the mouth or over the tongue and into the pharynx. It constitutes one of the most frequent and bothersome complaints of patients with Parkinson's disease (PD), affecting up to 84% of them. Sialorrhea is a distressing and challenging condition that may result in social isolation, embarrassment, depression, skin infections, poor oral health, and aspiration pneumonia. To better understand the burden of sialorrhea on patients with PD, Parkinson's Europe carried out a worldwide patient survey which showed that sialorrhea remains an underrecognized and undertreated issue in patients with PD. This is especially problematic because effective therapeutic options are available. This article presents the results of the Parkinson's Europe Sialorrhea Survey, which were considered by a multidisciplinary panel of experts to provide recommendations for improving the awareness, diagnosis, management, and treatment of sialorrhea in patients with PD. A shift in the treatment paradigm for sialorrhea in patients with PD is emerging. It is essential to better educate patients, family members, caregivers, and healthcare professionals about sialorrhea; to engage all those involved to actively discuss sialorrhea and measure its impact on quality of life; and to recognize the role of botulinum toxin and speech and language therapy as first-line therapies.
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Affiliation(s)
- Bruno Bergmans
- Department of Neurology, AZ St-Jan Brugge-Oostende AV, Campus Brugge, 8000 Bruges, Belgium
- Department of Neurology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Veronica Clark
- Independent Researcher, Malta Parkinson’s, PO Box 17, Marsa MTP 1001, Malta
- Private Practice, UK
| | - Stuart H. Isaacson
- Parkinson’s Disease and Movement Disorders Center of Boca Raton, 951 NW 13th Street, Bldg. 5-E, Boca Raton, FL 33486, USA
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, CBBM (Building 66), Ratzeburger Allee 160, 23562 Lübeck, Germany
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Berlowitz DJ, Mathers S, Hutchinson K, Hogden A, Carey KA, Graco M, Whelan BM, Charania S, Steyn F, Allcroft P, Crook A, Sheers NL. The complexity of multidisciplinary respiratory care in amyotrophic lateral sclerosis. Breathe (Sheff) 2023; 19:220269. [PMID: 37830099 PMCID: PMC10567075 DOI: 10.1183/20734735.0269-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/20/2023] [Indexed: 10/14/2023] Open
Abstract
Motor neurone disease/amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder with no known cure, where death is usually secondary to progressive respiratory failure. Assisting people with ALS through their disease journey is complex and supported by clinics that provide comprehensive multidisciplinary care (MDC). This review aims to apply both a respiratory and a complexity lens to the key roles and areas of practice within the MDC model in ALS. Models of noninvasive ventilation care, and considerations in the provision of palliative therapy, respiratory support, and speech and language therapy are discussed. The impact on people living with ALS of both inequitable funding models and the complexity of clinical care decisions are illustrated using case vignettes. Considerations of the impact of emerging antisense and gene modifying therapies on MDC challenges are also highlighted. The review seeks to illustrate how MDC members contribute to collective decision-making in ALS, how the sum of the parts is greater than any individual care component or health professional, and that the MDC per se adds value to the person living with ALS. Through this approach we hope to support clinicians to navigate the space between what are minimum, guideline-driven, standards of care and what excellent, person-centred ALS care that fully embraces complexity could be. Educational aims To highlight the complexities surrounding respiratory care in ALS.To alert clinicians to the risk that complexity of ALS care may modify the effectiveness of any specific, evidence-based therapy for ALS.To describe the importance of person-centred care and shared decision-making in optimising care in ALS.
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Affiliation(s)
- David J. Berlowitz
- The University of Melbourne, Parkville, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
- Department of Physiotherapy, Austin Health, Heidelberg, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia
| | - Susan Mathers
- Calvary Health Care Bethlehem, Caulfield South, Australia
- School of Clinical Sciences, Monash University, Clayton, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Central Coast Local Health District, Gosford, Australia
| | - Anne Hogden
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Kate A. Carey
- The University of Melbourne, Parkville, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
| | - Marnie Graco
- The University of Melbourne, Parkville, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
| | - Brooke-Mai Whelan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Salma Charania
- Motor Neurone Disease Association of Queensland, Oxley, Australia
| | - Frederik Steyn
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Peter Allcroft
- Southern Adelaide Palliative Services, Flinders Medical Centre, Bedford Park, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Ashley Crook
- Graduate School of Health, University of Technology Sydney, Chippendale, Australia
- Centre for MND Research and Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Nicole L. Sheers
- The University of Melbourne, Parkville, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
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11
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Ishida N, Ono S, Suzuki R, Nojiri K, Ootsuki S, Zakoji N. Comparison of factors associated with drooling between intractable neuromuscular disease and cerebral palsy. J Clin Neurosci 2023; 115:71-76. [PMID: 37499322 DOI: 10.1016/j.jocn.2023.07.013] [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: 01/31/2023] [Revised: 03/17/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
Drooling represents a common and noteworthy symptom in patients with intractable neuromuscular disease (IND) and cerebral palsy (CP) and can lead to poor quality of life (QOL) and higher incidence of death due to aspiration of saliva. Identifying the factors affecting drooling is crucial to improving QOL and improving the poor prognosis of patients with IND and CP. This study sought to assess the prevalence of drooling and to elucidate the associated factors, drugs, and differences between patients with IND and CP. We included hospitalized patients with IND and CP. Among the 269 patients, 69 of 162 patients with IND (42.6%) and 75 of 107 patients with CP (70.1%) exhibited drooling. Drooling in IND was significantly higher in patients with tube feeding and those who had a previous stroke than in patients with potential oral intake and those having no history of stroke. In individuals with CP, drooling was significantly negatively associated with age. Taltirelin in patients with IND had a significant positive association with drooling, and antipsychotics and centrally acting muscle relaxants in those with CP had a significant negative association with drooling. Our results suggest that the factors associated with frequent drooling differ between IND and CP cases, and patients who should be screened for drooling are those with decreased swallowing function, those with IND who have had a previous stroke, and young patients with CP. Moreover, clinicians should consider the impact of drugs on drooling in IND and CP cases.
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Affiliation(s)
- Natsuko Ishida
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Ishikawa, Japan.
| | - Shunsuke Ono
- Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical & Health Science, Kanazawa University, Ishikawa, Japan
| | - Ryohei Suzuki
- Department of Pharmacy, National Hospital Organization Higashinagoya National Hospital, Aichi, Japan
| | - Kei Nojiri
- Department of Pharmacy, National Hospital Organization Suzuka National Hospital, Mie, Japan; Department of Pharmacy, National Hospital Organization Shizuoka Medical Center, Shizuoka, Japan
| | - Shinnosuke Ootsuki
- Department of Pharmacy, Hokuriku Brain and Neuromuscular Disease Center, National Hospital Organization Iou National Hospital, Ishikawa, Japan
| | - Nobuyuki Zakoji
- Department of Pharmacy, National Hospital Organization Shizuoka Medical Center, Shizuoka, Japan
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12
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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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13
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Heikel T, Patel S, Ziai K, Shah SJ, Lighthall JG. Botulinum Toxin A in the Management of Pediatric Sialorrhea: A Systematic Review. Ann Otol Rhinol Laryngol 2023; 132:200-206. [PMID: 35176902 PMCID: PMC9834812 DOI: 10.1177/00034894221078365] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Botulinum toxin A is known to be effective and safe in managing sialorrhea in pediatric patients; however, there is no consensus on a protocol for optimal injection sites and appropriate dosing for injection. METHODS This review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. PubMed, EMBASE, and other databases were queried to identify articles that evaluated botulinum toxin type A for the treatment of sialorrhea in the pediatric population. A total of 405 studies were identified. After applying inclusion and exclusion criteria, 31 articles were included for review. RESULTS A total of 14 studies evaluated 2-gland injections, and 17 studies evaluated 4-gland injections. Of the 31 studies included, one study assessed incobotulinumtoxinA (Xeomin®) the remaining all used onabotulinumtoxinA (Botox®). For 2-gland injection studies, a combined total of 899 participants were reviewed, where 602 participants received 50 units into their submandibular glands, while 262 participants received 30 to 50 units. Among 4-gland injection studies, there was a combined total of 388 participants, with the most prevalent dosage utilized being 60 to 100 units in 230 participants, followed by 100 units total in 77 participants. The most common adverse event was dysphagia which resolved in nearly all cases. Three studies aimed to examine 2-gland versus 4-gland injections, with 2 of the studies concluding 4-gland injection was superior. CONCLUSIONS The strength of evidence suggests that the dosing of 50 units total of onabotulinumtoxinA to the submandibular glands is safe and effective in the pediatric population. For 4-gland injections, bilateral submandibular and parotid gland injections of 60 to 100 units total is the safe and effective dosage. There is no substantial evidence comparing 4-gland injections to 2-gland injections, but research thus far suggests 4-gland injections to be superior. Future study is needed to evaluate incobotulinumtoxinA and abobotulinumtoxinA dosages in the pediatric population.
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Affiliation(s)
- Tiffany Heikel
- Department of Otolaryngology—Head and
Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center,
Hershey, PA, USA
| | - Shivam Patel
- The Pennsylvania State University,
College of Medicine, Hershey, PA, USA
| | - Kasra Ziai
- Department of Otolaryngology—Head and
Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center,
Hershey, PA, USA
| | - Sejal J. Shah
- Department of Anesthesiology and
Perioperative Medicine, The Pennsylvania State University, Milton S. Hershey Medical
Center, Hershey, PA, USA
| | - Jessyka G. Lighthall
- Facial Plastic and Reconstructive
Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State
University, Milton S. Hershey Medical Center, Hershey, PA, USA
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14
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Ishida N, Oshima Y, Katsura A, Imamura R, Arakawa H, Shimada T, Mizuno S, Sai Y, Suga Y, Matsushita R. Application Site of Transdermal Scopolamine Influences Efficacy and Drug Concentration in Salivary Glands in Rats. Biol Pharm Bull 2023; 46:1805-1809. [PMID: 38044099 DOI: 10.1248/bpb.b23-00561] [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] [Indexed: 12/05/2023]
Abstract
Transdermal scopolamine applied to the postauricular area is used to treat drooling. We investigated the duration of action of scopolamine ointment and the effect of the application site on drug efficacy and concentration in the salivary glands of rats. Scopolamine ointment was applied to the skin over the salivary glands (SSG) and back (SB). Saliva volume was measured after intraperitoneal administration of pilocarpine. Blood and salivary glands were collected after scopolamine ointment application, and scopolamine concentrations in the plasma and salivary glands were measured. Saliva volume after application in the SSG group was significantly lower at all time points than in the non-treated group, and the change in saliva volume in the SSG group was greater than that in the SB group at all time points. This suggests that applying scopolamine ointment to the SSG strongly suppresses salivary secretion. Scopolamine concentration in the salivary glands of the SSG group was significantly higher at 9 h. The change in the efficacy of scopolamine ointment depending on the application site was due to the difference in transfer to the salivary glands. Transdermal administration of scopolamine to the skin over the salivary glands may have high efficiency in treating drooling.
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Affiliation(s)
- Natsuko Ishida
- Department of Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University
| | - Yoshitaka Oshima
- Department of Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University
| | - Ayano Katsura
- Department of Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University
| | - Rikako Imamura
- Department of Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University
| | - Hiroshi Arakawa
- Department of Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University
| | - Tsutomu Shimada
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University
- Department of Hospital Pharmacy, University Hospital, Kanazawa University
| | - Satoshi Mizuno
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University
| | - Yoshimichi Sai
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University
- Department of Hospital Pharmacy, University Hospital, Kanazawa University
| | - Yukio Suga
- Department of Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University
| | - Ryo Matsushita
- Department of Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University
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15
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Perez G, Young L, Kravitz R, Sheehan D, Adang L, Van Haren K, Lin JL, Jaffe NN, Kuo D, Ball L, Keller J, Sank J, DiVito D, Naime S. Pulmonological issues. Curr Probl Pediatr Adolesc Health Care 2022; 52:101313. [PMID: 36470809 PMCID: PMC11348663 DOI: 10.1016/j.cppeds.2022.101313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pediatric leukodystrophies are rare neurodegenerative diseases involving multiple systems. Each form has unique neurologic features but are characterized by encephalopathy with accompanying impairments evidenced in reflexes, muscle tone and movement control. Weakness of expiratory, inspiratory, and upper airway muscles may lead to impaired airway secretion clearance resulting in recurrent respiratory infections, dysphagia, sleep-disordered breathing, restrictive lung disease, and ultimately chronic respiratory insufficiency.
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Affiliation(s)
| | - Lisa Young
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Laura Adang
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Jody L Lin
- Universty of Utah, Salt Lake City, UT, USA
| | | | - Dennis Kuo
- Strong Memorial Hospital, Rochester, NY, USA
| | - Laura Ball
- Children's National Medical Center, Washington DC, USA
| | | | | | - Donna DiVito
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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16
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Riva A, Amadori E, Vari MS, Spalice A, Belcastro V, Viri M, Capodiferro D, Romeo A, Verrotti A, Striano P. Impact and management of drooling in children with neurological disorders: an Italian Delphi consensus. Ital J Pediatr 2022; 48:118. [PMID: 35854335 PMCID: PMC9297577 DOI: 10.1186/s13052-022-01312-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 06/24/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The rate of chronic drooling in children older than 4 years is 0.5%, but it rises to 60% in those with neurological disorders. Physical and psychosocial consequences lead to a reduction in the quality of Life (QoL) of affected patients; however, the problem remains under-recognized and under-treated. We conducted an Italian consensus through a modified Delphi survey to discuss the current treatment paradigm of drooling in pediatric patients with neurological disorders. METHODS After reviewing the literature, a board of 10 experts defined some statements to be administered to a multidisciplinary panel through an online encrypted platform. The answers to the questions were based on a 1-5 Likert scale (1 = strongly disagree; 5 = strongly agree). The scores were grouped into 1-2 (disagreement) and 4-5 (agreement), while 3 was discarded. The consensus was reached when the sum of the disagreement or agreement was ≥75%. RESULTS Fifteen statements covered three main topics, namely clinical manifestations and QoL, quantification of drooling, and treatment strategies. All statements reached consensus (≥75% agreement). The 55 Italian experts agreed that drooling should be assessed in all children with complex needs, having a major impact on the QoL. Attention should be paid to investigating posterior hypersalivation, which is often neglected but may lead to important clinical consequences. Given that the severity of drooling fluctuates over time, its management should be guided by the patients' current needs. Furthermore, the relative lack of validated and universal scales for drooling quantification limits the evaluation of the response to treatment. Finally, the shared therapeutic paradigm is progressive, with conservative treatments preceding the pharmacological ones and reserving surgery only for selected cases. CONCLUSION This study demonstrates the pivotal importance of a multidisciplinary approach to the management of drooling. National experts agree that progressive treatment can reduce the incidence of complications, improve the QoL of patients and caregivers, and save healthcare resources. Finally, this study highlights how the therapeutic strategy should be reconsidered over time according to the available drugs on the market, the progression of symptoms, and the patients' needs.
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Affiliation(s)
- Antonella Riva
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Via Gaslini 5, 16148, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
| | - Elisabetta Amadori
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Via Gaslini 5, 16148, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
| | - Maria Stella Vari
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Via Gaslini 5, 16148, Genoa, Italy
| | - Alberto Spalice
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | | | - Maurizio Viri
- Department of Child Neuropsychiatry, Hospital Maggiore della Carità, Novara, Italy
| | - Donatella Capodiferro
- Department of Biomedical Sciences and Human Oncology, Neonatology and Intensive Care Neonatal Unit Section, University of Bari Aldo Moro, Bari, Italy
| | - Antonino Romeo
- Pediatric Neurology Unit and Epilepsy Center, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | | | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Via Gaslini 5, 16148, Genoa, Italy. .,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy.
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17
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Jost WH, Bäumer T, Berweck S, Laskawi R, Spittau B, Steffen A, Winterholler M. [Therapy of Sialorrhea with Botulinum Toxin - An Update]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022; 90:222-232. [PMID: 35453157 DOI: 10.1055/a-1802-3867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The most important salivary glands are the paired parotid and submandibular glands. Adults produce 1 to 1.5 liters of saliva which are then regularly swallowed. When the act of swallowing is disturbed, salivation occurs. More rarely, the cause can be found in increased saliva production, for example, when caused through medication. Sialorrhea impairs the quality of life substantially and is frequently often socially stigmatizing. Therapy includes conservative measures such as functional dysphagia therapy, oral or transdermal application of anticholinergics, as well as, in selected cases, radiation and surgical measures. Over the last 20 years, local injection of botulinum toxin has been successfully applied in the treatment of this condition. With approval of incobotulinumtoxinA toxin for children and adults, this procedure will become the therapy of choice for chronic sialorrhea. The results of the phase III registration trials have demonstrated high efficacy and good safety of the injection treatment in both children and adults.
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Affiliation(s)
| | - Tobias Bäumer
- Institut für Systemische Motorikforschung, CBBM, Sektion Zentrum für Seltene Erkrankungen, UKSH, Universität zu Lübeck, Lübeck, Germany
| | - Steffen Berweck
- Schön Klinik Vogtareuth, Vogtareuth, Germany.,Dr von Haunersches Kinderspital Kinderklinik und Kinderpoliklinik der Ludwig Maximilian Universitat München, München, Germany
| | - Rainer Laskawi
- Georg-August-Universitat Göttingen HNO-Klinik, Göttingen, Germany
| | - Björn Spittau
- Anatomie und Zellbiologie, Medizinische Fakultät OWL, Universität Bielefeld, Bielefeld, Germany
| | - Armin Steffen
- Universitätsklinikum Schleswig-Holstein Campus Lübeck HNO Klinik, Lübeck, Germany
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18
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A Case Report of Systemic Intoxication Following Onabotulinum Toxin A Injections Into the Salivary Glands in a Patient With Spinal Muscular Atrophy Type 1. Pediatr Neurol 2022; 129:37-38. [PMID: 35217275 DOI: 10.1016/j.pediatrneurol.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sialorrhea in spinal muscular atrophy (SMA) is caused by bulbar weakness, which is aggravated by low oromotor tone rather than saliva overproduction. Botulinum toxin (BTX) reduces sialorrhea by preventing acetylcholine release from the presynaptic secretory parasympathetic nerve terminals. An important adverse effect of BTX, as highlighted in its black box warning, is a systemic spread of BTX leading to botulismlike symptoms including dysphagia, muscle weakness, and death. These symptoms may be more pronounced in peripheral motor neuropathic disorder population such as SMA, whose neuromuscular junction (NMJ) is already dysfunctional. METHODS We report a case of a 17-month-old boy with SMA type 1 following BTX injection for the treatment of sialorrhea. RESULTS The boy developed severe generalized hypotonia, profound dysphagia, decreased airway clearance, and speech difficulty following BTX injection. Full gastric feeding was required. Pyridostigmine was started but with minimal effect. The patient experienced prolonged deleterious side effects of BTX, lasting upward of a year with very slow recovery of limb strengths and oromotor tone. CONCLUSIONS NMJ dysfunction has been well described in SMA. BTX may exacerbate fragile NMJ function by inhibiting acetylcholine release at the presynaptic vesicles. As such, systematic intoxication of BTX can have far-reaching consequences in this population. A strong precaution and cautious weighing of efficacy and risk must be performed before utilizing BTX in the SMA population.
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19
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Sadeghi M, Zakariaei Z, Soleymani M, Malakian A. Occurrence of acute cholinergic syndrome in an infant due to donepezil ingestion. Clin Case Rep 2022; 10:e05469. [PMID: 35369389 PMCID: PMC8859403 DOI: 10.1002/ccr3.5469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/23/2022] [Accepted: 02/06/2022] [Indexed: 11/08/2022] Open
Abstract
Donepezil and acetyl cholinesterase inhibitors are the most commonly prescribed medications for the treatment of Alzheimer's disease. We describe a 2-year-old infant who was referred to the emergency department after developing cholinergic syndrome 6 hours after ingesting 10 mg of his grandmother's donepezil tablets and was finally discharged in stable condition.
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Affiliation(s)
| | - Zakaria Zakariaei
- Toxicology and Forensic Medicine DivisionOrthopedic Research CenterImam Khomeini HospitalMazandaran University of Medical SciencesSariIran
- Toxoplasmosis Research CenterCommunicable Diseases InstituteIranian National Registry Center for Lophomoniasis and ToxoplasmosisMazandaran University of Medical SciencesSariIran
| | - Mostafa Soleymani
- Toxoplasmosis Research CenterCommunicable Diseases InstituteIranian National Registry Center for Lophomoniasis and ToxoplasmosisMazandaran University of Medical SciencesSariIran
| | - Abdollah Malakian
- Faculty of MedicineDepartment of Emergency MedicineMazandaran University of Medical SciencesSariIran
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20
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21
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Kalmar CL, Patel VA, Zapatero ZD, Kosyk MS, Taylor JA, Swanson JW. Submandibular Gland Excision in Pediatric Patients. J Craniofac Surg 2021; 32:2656-2659. [PMID: 34727467 DOI: 10.1097/scs.0000000000007887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Children who require submandibular gland excision for ptyalism often have multiple associated comorbidities, including neurodevelopmental disorders and respiratory risk factors. The purpose of this study is to utilize a large multicenter database to elucidate the perioperative profile of submandibular gland excision in children, with particular focus on children who require submandibular gland excision for ptyalism. METHODS The American College of Surgeons National Surgical Quality Improvement Program Pediatric dataset was queried for submandibular gland excision performed from 2012 through 2018. Indications were subclassified based on International Classification of Disease (ICD)-9 and ICD-10 codes. Complications, readmissions, and reoperations were analyzed with appropriate statistics. RESULTS During the study interval, 304 pediatric patients underwent submandibular gland excision, which was mostly performed for ptyalism (56.9%), followed by inflammatory conditions (20.7%). Patients requiring submandibular gland excision for ptyalism were significantly younger (P < 0.001) and underwent significantly longer procedures (P < 0.001). Ptyalism was associated with significantly higher related adverse events (P = 0.010), related readmission (P = 0.013), and medical complications (P = 0.013), which included a significantly higher risk of pneumonia (P = 0.050). Children with ptyalism had significantly higher rates of overall respiratory comorbidities (P < 0.001), including chronic lung disease (P < 0.001), supplemental oxygen support (P < 0.001), tracheostomy (P < 0.001), and ventilator dependence (P < 0.001). Patients undergoing submandibular gland excision for benign (P all ≥ 0.082) and malignant (P all ≥ 0.565) neoplasms did not have significantly higher rates of any indexed postoperative adverse event. CONCLUSIONS Children requiring submandibular gland excision for ptyalism represent a unique cohort than those requiring excision for other indications, with significantly higher burden of preoperative risk factors, intraoperative durations, and postoperative adverse events.
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Affiliation(s)
- Christopher L Kalmar
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia
| | - Vijay A Patel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Zachary D Zapatero
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia
| | - Mychajlo S Kosyk
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia
| | - Jesse A Taylor
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia
| | - Jordan W Swanson
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia
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22
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Carannante N, Annunziata A, Coppola A, Simioli F, Marotta A, Bernardo M, Piscitelli E, Imitazione P, Fiorentino G. Diagnosis and treatment of pneumonia, a common cause of respiratory failure in patients with neuromuscular disorders. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2021; 40:124-131. [PMID: 34632294 PMCID: PMC8489170 DOI: 10.36185/2532-1900-053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/13/2021] [Indexed: 11/12/2022]
Abstract
Patients with neuromuscular diseases, during their illness are more susceptible to respiratory infections due to predisposing factors. Ineffective cough and the presence of atelectasis and hypoventilation, dysphagia and drooling can represent risk factors for the development of respiratory infection and fatal respiratory failure. Infections of respiratory tract with acute respiratory failure are the most common reason for hospitalizations, and pneumonia is among the leading causes of morbidity and mortality worldwide. The setting in which pneumonia is acquired heavily influences diagnostic and therapeutic choices. We will focus on aetiopathogenesis, diagnosis and treatment of pneumonia in these subjects, particularly considering the disease severity, rates of antibiotic resistance and the possible complications. In this case consultations with specialized physicians are strongly recommended.
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Affiliation(s)
| | - Anna Annunziata
- Unità of Fisiopatologia e Riabilitazione Respiratoria AO Ospedali dei Colli, Naples, Italy
| | - Antonietta Coppola
- Unità of Fisiopatologia e Riabilitazione Respiratoria AO Ospedali dei Colli, Naples, Italy
| | - Francesca Simioli
- Unità of Fisiopatologia e Riabilitazione Respiratoria AO Ospedali dei Colli, Naples, Italy
| | - Antonella Marotta
- Unità of Fisiopatologia e Riabilitazione Respiratoria AO Ospedali dei Colli, Naples, Italy
| | - Mariano Bernardo
- Unit of Microbiology and Virology AO Ospedali dei Colli, Naples, Italy
| | | | - Pasquale Imitazione
- Unità of Fisiopatologia e Riabilitazione Respiratoria AO Ospedali dei Colli, Naples, Italy
| | - Giuseppe Fiorentino
- Unità of Fisiopatologia e Riabilitazione Respiratoria AO Ospedali dei Colli, Naples, Italy
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23
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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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24
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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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25
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Riva A, Federici C, Piccolo G, Amadori E, Verrotti A, Striano P. Exploring treatments for drooling in children with neurological disorders. Expert Rev Neurother 2020; 21:179-187. [PMID: 33222543 DOI: 10.1080/14737175.2021.1855146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Introduction: Drooling represents a major problem in the every-day life of pediatric patients with neurological disorders. The significant burden, both physical and socio-psychological, of the disorder requires adequate clinical evaluation and proper management. However, treating drooling remains a challenge for clinicians. This is a review of the most up-to-date therapeutic options for the treatment of drooling in the pediatric population, hence both conservative, pharmacological, and surgical approaches are discussed. Areas covered: Randomized clinical trials (RCTs), structured reviews, and case reports are included. Special focus is paid on the methods used to evaluate the efficacy and safety outcomes in the selected RCTs, trying to promote the use of more validated scales to assess drooling in the future. Expert opinion: The lack of reliable metrics to assess efficacy and safety outcomes in drooling limits researchers from identifying the best patient-suitable treatment. The relatively small number of clinical trials carried out over the last two decades is also due to the difficulty in assessing drooling using subjective scales. A key enabler for new efficient therapies stands in the introduction of accurate and robust metrics to measure treatment effectiveness on drooling.
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Affiliation(s)
- Antonella Riva
- Pediatric Neurology and Muscular Diseases Unit, IRRCS Istituto Giannina Gaslini , Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università Degli Studi di Genova , Genova, Italy
| | - Camilla Federici
- Pediatric Neurology and Muscular Diseases Unit, IRRCS Istituto Giannina Gaslini , Genova, Italy
| | - Gianluca Piccolo
- Pediatric Neurology and Muscular Diseases Unit, IRRCS Istituto Giannina Gaslini , Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università Degli Studi di Genova , Genova, Italy
| | - Elisabetta Amadori
- Pediatric Neurology and Muscular Diseases Unit, IRRCS Istituto Giannina Gaslini , Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università Degli Studi di Genova , Genova, Italy
| | - Alberto Verrotti
- Department of Pediatrics, Università Degli Studi dell'Aquila , University of Perugia, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRRCS Istituto Giannina Gaslini , Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università Degli Studi di Genova , Genova, Italy
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26
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Sialorrhea in Parkinson's Disease. Toxins (Basel) 2020; 12:toxins12110691. [PMID: 33142833 PMCID: PMC7692771 DOI: 10.3390/toxins12110691] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022] Open
Abstract
Sialorrhea, or excessive saliva beyond the margin of the lip, is a common problem in many neurological diseases. Previously, sialorrhea has been underrecognized in Parkinson’s disease (PD) patients. Despite this, many patients rank sialorrhea as one of the most debilitating complaints of Parkinson’s disease. Previous treatment for sialorrhea has been suboptimal and has been plagued by significant side effects that are bothersome and can be dangerous in patients with a concurrent neurodegenerative disease. This review sought to review the anatomy, function, and etiology of sialorrhea in PD. It then sought to examine the evidence for the different treatments of sialorrhea in PD, and further examined newer evidence for safety and efficacy in minimally invasive treatment such as botulinum toxin.
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27
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Al Jeraisy M, AlFuraih M, AlSaif R, AlKhalifah B, AlOtaibi H, Abolfotouh MA. Efficacy of scopolamine transdermal patch in children with sialorrhea in a pediatric tertiary care hospital. BMC Pediatr 2020; 20:437. [PMID: 32943036 PMCID: PMC7495848 DOI: 10.1186/s12887-020-02336-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Drooling is common in children with neurological disorders, but its management is very challenging, Scopolamine transdermal patch (STP) appears to be useful in controlling drooling, although it is not approved for this indication and there are limited clinical studies about its effectiveness. This study aimed (1) to assess the impact of STP use on the severity of drooling and on the frequency of emergency department (ED) and hospital readmission (RA) visits related to drooling, and (2) to determine the level of family satisfaction with STP when used in children with neurological disorders. METHODS This is a retrospective cohort study of all pediatric patients aged 3-14 years, with non-progressive neurodevelopmental disability, who used STP for more than one year during the period between April 2015 and July 2018 (n = 44). Data on demographics, clinical status, comorbidities, STP dose and duration, other medications, ED and RA visits were collected. Follow-up phone-call interviews with parents/caregivers were performed using a parent-reported frequency and severity rating scale of sialorrhea. Absolute and relative risk reductions were calculated to assess the impact of STP on ED and RA visits. Significance was considered at p-value of ≤ 0.05. RESULTS STP use showed significant reduction in severity of drooling (p < 0.001), wiping of the child's mouth (p < 0.001), bibs or clothing changes (p < 0.001), choking and aspiration of saliva (p = 0.001). The Relative Risk Reduction of the drooling-related ED and RA visits were 86% and 67% respectively. Nearly two-thirds (60%) of caregivers were satisfied with using STP. CONCLUSIONS This is the first study of its kind done in Saudi Arabia demonstrating favorable impact of STP use by children on the consequences associated with drooling and with the frequency of ER and RA visits due to drooling. Development of a medication use protocol is recommended to standardize STP treatment in order to optimize its effectiveness. This study serves as baseline information for future prospective interventional studies.
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Affiliation(s)
- Majed Al Jeraisy
- Pharmaceutical Care Department, King Abdullah Specialized Children Hospital, Ministry of National Guard, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia. .,College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
| | - Maissa AlFuraih
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Raghad AlSaif
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | - Hazza AlOtaibi
- Pharmaceutical Care Department, King Abdullah Specialized Children Hospital, Ministry of National Guard, Riyadh, Saudi Arabia
| | - Mostafa A Abolfotouh
- King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
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28
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Letawsky VH, Schreiber AM, Skoretz SA. A Tutorial on Saliva's Role in Swallowing With a Focus on Sjögren's Syndrome. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1307-1319. [PMID: 32531172 DOI: 10.1044/2020_ajslp-19-00083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Saliva is integral to swallowing and necessary for oral health. Understanding saliva's origin and properties is important for swallowing assessment and management. Diseases such as Sjögren's syndrome (SS) can affect saliva negatively, often contributing to dysphagia. Our objectives are to (a) highlight saliva's fundamental role in swallowing, (b) provide a bibliometric overview of literature pertaining to SS pathophysiology and effects on saliva, (c) explore implications of salivary changes on swallowing and quality of life in SS and other populations, and (d) provide suggestions for systematic saliva assessment in practice. Method This tutorial reviews saliva production, composition, and involvement in swallowing within health and disease. Using rapid review methodology, we outline the effect of SS on saliva and describe SS etiology, diagnosis, and treatment. We discuss formal saliva assessments and a multidisciplinary approach. Results Saliva plays a vital role in swallowing, particularly lubrication, bolus formation, and oral health. SS affects the salivary glands altering salivary flow rate and composition. We identified 55 studies (N) measuring salivary changes, grouping them according to four strata demarcated by SS classification criteria updates. For some, xerostomia, dysphagia, and reduced life quality result. Formal saliva assessments include the Clinical Oral Dryness Score, Xerostomia Inventory, and Secretion Rating Scale. Multidisciplinary care is optimal for patients with salivary changes. Conclusion Understanding salivary changes in disease may enhance understanding of swallowing and inform dysphagia practice. Expanding swallowing assessments with formal saliva evaluations, and patient perspectives thereof, may aid in developing bespoke treatments, ultimately improving outcomes and quality of life. Supplemental Material https://doi.org/10.23641/asha.12456449.
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Affiliation(s)
- Veronica H Letawsky
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Ann-Marie Schreiber
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Stacey A Skoretz
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Providence Health Care, Vancouver, Canada
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29
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Isaacson SH, Ondo W, Jackson CE, Trosch RM, Molho E, Pagan F, Lew M, Dashtipour K, Clinch T, Espay AJ. Safety and Efficacy of RimabotulinumtoxinB for Treatment of Sialorrhea in Adults: A Randomized Clinical Trial. JAMA Neurol 2020; 77:461-469. [PMID: 31930364 PMCID: PMC6990829 DOI: 10.1001/jamaneurol.2019.4565] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Question Are rimabotulinumtoxinB injections safe and effective for management of sialorrhea in adults? Findings In this randomized clinical trial of 187 adults with sialorrhea, rimabotulinumtoxinB injections (2500 U and 3500 U) appeared to statistically significantly reduce sialorrhea vs placebo (treatment effect, −0.30 for both doses vs placebo, P < .001). Therapeutic benefits were seen as early as 1 week after injection and persisted for 11 to 15 weeks. Meaning RimabotulinumtoxinB is a safe, effective, and well-tolerated treatment for sialorrhea in adults. Importance RimabotulinumtoxinB (RIMA) may be preferable as an anti-sialorrhea treatment compared with current oral anticholinergic drugs in people with neurological disorders. Objective To assess the safety, efficacy, and tolerability of RIMA injections for the treatment of sialorrhea in adults. Design, Setting, and Participants This randomized, parallel, double-blind, placebo-controlled clinical trial of RIMA 2500 U and 3500 U was conducted from November 14, 2013, to January 23, 2017. A total of 249 adult patients with troublesome sialorrhea secondary to any disorder or cause were screened. Of them, 13 refused further participation in the study or were lost to follow-up and 49 did not fulfill the criteria for participation; 187 were ultimately enrolled. Patients had to have a minimum unstimulated salivary flow rate (USFR) of 0.2 g/min and a minimum Drooling Frequency and Severity Scale score of 4. Exposures Patients were randomized 1:1:1 to RIMA, 2500 U (n = 63); RIMA, 3500 U (n = 64); or placebo (n = 60). Main Outcomes and Measures Primary outcomes were the change in USFR from baseline to week 4 and the Clinical Global Impression of Change (CGI-C) at week 4. The CGI-C scores were recorded on a 7-point scale ranging from very much improved to very much worse. Adverse events were recorded throughout the trial period. Results Of 187 patients enrolled (147 men [78.6%]; mean [SD] age, 63.9 [13.3] years), 122 patients had Parkinson disease (65.2%), 13 (7.0%) were stroke survivors, 12 had amyotrophic lateral sclerosis (6.4%), 6 had medication-induced sialorrhea (3.2%), 4 had adult cerebral palsy (2.1%), and 30 had sialorrhea owing to other causes (16.0%). A total of 176 completed the study. Treatment with both doses of RIMA significantly reduced USFR at week 4 vs placebo (mean treatment difference, −0.30 g/min [95% CI, −0.39 to −0.21] for both doses vs placebo, P < .001). The CGI-C scores were statistically significantly improved at week 4 for both treatment groups vs placebo (−1.21 [95% CI, −1.56 to −0.87] for 2500 U, −1.14 [95% CI, −1.49 to −0.80] for 3500 U, both P < .001). Treatment benefits were seen as early as 1 week after injection and were maintained over the treatment cycle of approximately 13 weeks. The RIMA injections were well tolerated compared with placebo. The most common adverse events were self-limited mild to moderate dry mouth, dysphagia, and dental caries. Conclusions and Relevance Treatment with RIMA (2500 U and 3500 U) in adults was well tolerated and reduced sialorrhea, with the onset of the effect at 1 week after the injection. These data support the clinical use of RIMA in the management of sialorrhea in adults. Trial Registration ClinicalTrials.gov Identifier: NCT01994109
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Affiliation(s)
- Stuart H Isaacson
- Parkinson's Disease and Movement Disorder Center of Boca Raton, Boca Raton, Florida
| | - William Ondo
- Houston Methodist Neurological Institute, Houston, Texas.,Weill Cornell Medicine, Houston, Texas
| | | | | | - Eric Molho
- Parkinson's Disease and Movement Disorder Center, Albany Medical Center, Albany, New York
| | | | - Mark Lew
- Keck School of Medicine of University of Southern California, Los Angeles
| | | | | | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
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30
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Lui SK, Neo SHS, Quah DSC. The Challenges Faced and Lessons Learnt in the Multidisciplinary Management of Medication Refractory Post-Stroke Sialorrhea: A Case Report. Cureus 2020; 12:e7978. [PMID: 32523835 PMCID: PMC7273414 DOI: 10.7759/cureus.7978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Post-stroke sialorrhea is a very debilitating condition that negatively impacts a person’s physical and psychological health. In this report, we discuss a case of medication refractory post-stroke sialorrhea in a female patient. The patient received multidisciplinary management and two fractions of radiotherapy over a course of five months. The treatment was successful, and the patient reported satisfactory control of her sialorrhea symptoms. We hope to highlight the importance of multidisciplinary management and consideration of radiotherapy as a treatment modality when providing care for medication refractory post-stroke sialorrhea patients who are unsuitable for salivary gland botulinum toxin (BoNT) injection and surgery.
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Affiliation(s)
- Siew Kwaon Lui
- Rehabilitation Medicine, Singapore General Hospital, Singapore, SGP
| | | | - Daniel Song Chiek Quah
- Radiation Oncology, National Cancer Centre, Singapore, SGP.,Supportive and Palliative Care, National Cancer Centre, Singapore, SGP
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31
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Loens S, Brüggemann N, Steffen A, Bäumer T. Localization of Salivary Glands for Botulinum Toxin Treatment: Ultrasound Versus Landmark Guidance. Mov Disord Clin Pract 2019; 7:194-198. [PMID: 32071939 DOI: 10.1002/mdc3.12881] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/05/2019] [Accepted: 12/01/2019] [Indexed: 11/05/2022] Open
Abstract
Background Sialorrhea is a troublesome symptom in a variety of neurological diseases. Recently, local injection of botulinum toxin into the salivary glands was approved for treatment of sialorrhea, and injection guidance by anatomical landmarks was suggested. Objective To compare the accuracy of ultrasound versus previously proposed anatomical landmarks for localizing the salivary glands. Methods In a cross-sectional study in 21 adults, landmark positions (LM) of the parotid gland (PG) and the submandibular gland (SG) were identified following published recommendations. The ultrasound position (US) was defined as the position representing the maximum gland thickness. The distance between positions, gland thickness, and optimal injection depth were recorded by US. Results Gland thickness differed significantly between LM and US positions (PG, 4 vs. 17.8 mm; P < 0.001; SG, 3.5 vs. 13.6 mm; P < 0.001). The spatial deviation between the recommended LM and identified US positions in the horizontal plane was 21 mm to the posterior direction for the PG and 19.6 mm for the SG. The deviation in vertical orientation was small for both glands; however, there was a positive correlation between the distance from the SG to the mandibular bone with age. The optimal injection depth measured by US was 11.8 mm for the PG and 13.6 mm for the SG. This showed to be positively correlated with the body mass index. Conclusions The position of the salivary glands differs from proposed landmarks and depends on the individual age and body weight; therefore, we recommend ultrasound guidance for injection.
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Affiliation(s)
- Sebastian Loens
- Institute of Neurogenetics University of Luebeck Luebeck Germany
| | - Norbert Brüggemann
- Institute of Neurogenetics University of Luebeck Luebeck Germany.,Department of Neurology University of Luebeck Luebeck Germany
| | - Armin Steffen
- Department for Otorhinolaryngology University of Luebeck Luebeck Germany
| | - Tobias Bäumer
- Institute of Neurogenetics University of Luebeck Luebeck Germany
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32
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Jost WH, Bäumer T, Laskawi R, Slawek J, Spittau B, Steffen A, Winterholler M, Bavikatte G. Therapy of Sialorrhea with Botulinum Neurotoxin. Neurol Ther 2019; 8:273-288. [PMID: 31542879 PMCID: PMC6858891 DOI: 10.1007/s40120-019-00155-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Indexed: 12/11/2022] Open
Abstract
Botulinum neurotoxin (BoNT) is considered the treatment of choice for various symptoms and diseases such as focal dystonia and focal spasticity. The effects of BoNT on the salivary glands have also been known for years, but their use was limited because of a lack of approval studies. Now the indication of sialorrhea is approved in some countries for incobotulinumtoxinA, such as the USA and Europe, and therapy could also become the treatment of choice. According to the pivotal study, a dose of 100 units of incobotulinumtoxinA, which is divided into the parotid and submandibular glands, is recommended. RimabotulinumtoxinB is approved in the USA only. To define the value of this therapy, we must consider anatomy, physiology, and available therapies. Therapy includes conservative measures such as functional dysphagia therapy, oral or transdermal application of anticholinergics, and, in selected cases, radiotherapy and surgical procedures. A combination of different approaches is optional. On the basis of the evidence and clinical experience, BoNT injections will be the first line of pharmacotherapy for chronic sialorrhea.
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Affiliation(s)
| | - Tobias Bäumer
- Paediatric and Adult Movement Disorders and Neuropsychiatry, Institut of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Rainer Laskawi
- ENT Department, University Medical Center, Göttingen, Germany
| | - Jaroslaw Slawek
- Neurology Department, Medical University of Gdansk, Gdańsk, Poland
| | - Björn Spittau
- Center for Transdisciplinary Neurosciences Rostock (CTNR), University of Rostock, Rostock, Germany
| | - Armin Steffen
- Department for Otorhinolaryngology, University of Lübeck, UKSH, Lübeck, Germany
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33
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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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34
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Jost WH, Friedman A, Michel O, Oehlwein C, Slawek J, Bogucki A, Ochudlo S, Banach M, Pagan F, Flatau-Baqué B, Dorsch U, Csikós J, Blitzer A. Long-term incobotulinumtoxinA treatment for chronic sialorrhea: Efficacy and safety over 64 weeks. Parkinsonism Relat Disord 2019; 70:23-30. [PMID: 31794936 DOI: 10.1016/j.parkreldis.2019.11.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/15/2019] [Accepted: 11/26/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Botulinum neurotoxin (BoNT) is an effective treatment for chronic sialorrhea; however, reliable and robust evidence supporting long-term efficacy and safety is lacking. This study investigated the efficacy and safety of repeated incobotulinumtoxinA injections for chronic sialorrhea over 64 weeks. METHODS Adults with sialorrhea were randomized (2:2:1) to incobotulinumtoxinA 75 U, incobotulinumtoxinA 100 U (n = 74 each), or placebo (n = 36) in the double-blind, placebo-controlled main period (NCT02091739). Eligible subjects entered the extension period and received dose-blinded incobotulinumtoxinA 75 or 100 U in three further 16±2-week injection cycles. Efficacy and safety assessments in subjects who received incobotulinumtoxinA throughout the study included unstimulated salivary flow rate (uSFR), subjects' Global Impression of Change Scale (GICS), Drooling Severity and Frequency Scale (DSFS), modified Radboud Oral Motor Inventory for Parkinson's Disease (mROMP) drooling, speech, and swallowing symptom scores, and incidence of adverse events (AEs). RESULTS In total, 173/184 subjects (94%) completed the main period and entered the extension period; 141 subjects received incobotulinumtoxinA 75 U (n = 69) or 100 U (n = 72) in both periods. Mean uSFR decreased consistently with repeated incobotulinumtoxinA 75 and 100 U treatment and by -0.16 and -0.17, respectively, at the end-of-study visit. Subjects' GICS, DSFS, and mROMP drooling scores also improved at all assessments. mROMP speech and swallowing scores remained stable. The most common treatment-related AEs during the extension period were dry mouth (4.4% and 11.1%) and dysphagia (1.5% and 4.2%). CONCLUSIONS Data support long-term efficacy and safety of repeated incobotulinumtoxinA treatment for sialorrhea, with no additional safety concerns reported over 64 weeks.
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Affiliation(s)
| | - Andrzej Friedman
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland.
| | - Olaf Michel
- Department of Otorhinolaryngology, University Hospital Brussels, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation, Gera, Germany.
| | - Jaroslaw Slawek
- Department of Neurological-Psychiatric Nursing, Medical University of Gdansk, Gdansk, Poland; Neurology Department, St Adalbert Hospital, Gdansk, Poland.
| | - Andrzej Bogucki
- Department of Extrapyramidal Diseases, Medical University of Łódź, Łódź, Poland.
| | - Stanislaw Ochudlo
- Department of Neurology and Stroke Unit, Medical University of Silesia, Katowice, Poland.
| | - Marta Banach
- Department of Neurology, Collegium Medicum, Jagiellonian University Medical College, Krakow, Poland.
| | - Fernando Pagan
- Department of Neurology, Georgetown University Hospital, Washington DC, USA.
| | | | - Ulrike Dorsch
- Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany.
| | - János Csikós
- Formerly of Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany.
| | - Andrew Blitzer
- Department of Otolaryngology/Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Neurology, Icahn School of Medicine at Mt. Sinai, New York, NY, USA; NY Center for Voice and Swallowing Disorders, New York, NY, USA.
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Varley LP, Denieffe S, O'Gorman C, Murphy A, Gooney M. A systematic review of noninvasive and invasive sialorrhoea management. J Clin Nurs 2019; 28:4190-4206. [DOI: 10.1111/jocn.15009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/29/2019] [Accepted: 06/30/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Li Ping Varley
- Department of Nursing and Health Care, School of Health Sciences Waterford Institute of Technology Waterford Ireland
| | - Suzanne Denieffe
- School of Humanities Waterford Institute of Technology Waterford Ireland
| | - Claire O'Gorman
- Department of Nursing and Health Care, School of Health Sciences Waterford Institute of Technology Waterford Ireland
| | - Annette Murphy
- Department of Nursing and Health Care, School of Health Sciences Waterford Institute of Technology Waterford Ireland
| | - Martina Gooney
- Department of Nursing and Health Care, School of Health Sciences Waterford Institute of Technology Waterford Ireland
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IncobotulinumtoxinA for hypersalivation in patients with amyotrophic lateral sclerosis: an open-label single-centre study. J Neural Transm (Vienna) 2019; 126:1341-1345. [PMID: 31317261 DOI: 10.1007/s00702-019-02044-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/07/2019] [Indexed: 12/11/2022]
Abstract
The objective of this study is to discover whether incobotulinumtoxinA (inco) can reduce relative hypersalivation in patients with amyotrophic lateral sclerosis (ALS). 14 patients with ALS (8 males and 6 females, age 55.4 ± 16.3 years) received ultrasound-guided injection of inco 100 MU in both parotid glands and inco 50 MU in both submandibular glands. Saliva production was gravimetrically measured with three cotton rolls placed in the mouth. Weight increase after 5 min was measured on an electronic scale. Subjective saliva production was registered with drooling frequency scale (DFS) and drooling severity scale (DSS). Saliva production was gravimetrically reduced at week 4 (p = 0.04), week 8 (p = 0.01) but not after week 12 after BT application. DFS was reduced at week 4 (p = 0.04), week 8 (p = 0.02), but not after week 12. DSS was reduced at week 4 (p = 0.03), week 8 (p = 0.04) and week 12 (p = 0.04). Patients in our study did not experience changes in their swallowing patterns or any other safety-relevant events. Inco is effective and well tolerated for saliva reduction in patients with ALS for 8-12 weeks.
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Regueira LS, Baratella‐Evêncio L, Oliveira JB, Silva PSOC, Valença GAL, Conceição JCP, Cruz Perez DE. Effects of chronic treatment with botulinum toxin type A in salivary glands of rats: Histological and immunohistochemical analyses. J Oral Pathol Med 2019; 48:728-734. [DOI: 10.1111/jop.12887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 04/27/2019] [Accepted: 05/27/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | | | - Danyel Elias Cruz Perez
- Department of Clinical and Preventive Dentistry, School of Dentistry Universidade Federal de Pernambuco Recife Brazil
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Jost WH, Friedman A, Michel O, Oehlwein C, Slawek J, Bogucki A, Ochudlo S, Banach M, Pagan F, Flatau-Baqué B, Csikós J, Cairney CJ, Blitzer A. SIAXI: Placebo-controlled, randomized, double-blind study of incobotulinumtoxinA for sialorrhea. Neurology 2019; 92:e1982-e1991. [PMID: 30918101 PMCID: PMC6511076 DOI: 10.1212/wnl.0000000000007368] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/03/2019] [Indexed: 12/15/2022] Open
Abstract
Objective This pivotal phase III study, SIAXI, investigated the efficacy and safety of incobotulinumtoxinA for the treatment of chronic sialorrhea due to Parkinson disease (PD), atypical parkinsonism, stroke, or traumatic brain injury (TBI). Methods Adult patients with PD (70.7%), atypical parkinsonism (8.7%), stroke (19.0%), or TBI (2.7%) were randomized (2:2:1) to double-blind treatment with placebo (n = 36), or total doses of incobotulinumtoxinA 75 U (n = 74) or 100 U (n = 74), in a single treatment cycle. The coprimary endpoints were change in unstimulated salivary flow rate from baseline to week 4, and patients' Global Impression of Change Scale score at week 4. Adverse events were recorded throughout. Results A total of 184 patients were randomized. Both incobotulinumtoxinA dose groups showed reductions in mean unstimulated salivary flow rate at week 4, with a significant difference vs placebo in the incobotulinumtoxinA 100 U group (p = 0.004). Patients' Global Impression of Change Scale scores also improved at week 4, with a significant difference vs placebo in the incobotulinumtoxinA 100 U group (p = 0.002). A lasting effect was observed at week 16 post injection. The most frequent treatment-related adverse events in the incobotulinumtoxinA 75 U and 100 U groups were dry mouth (5.4% and 2.7% of patients) and dysphagia (2.7% and 0.0% of patients). Conclusions IncobotulinumtoxinA 100 U is an effective and well-tolerated treatment of chronic sialorrhea in adults. ClinicalTrials.gov identifier NCT02091739. Classification of evidence This study provides Class I evidence that incobotulinumtoxinA reduces salivary flow rates in patients with chronic sialorrhea due to PD, atypical parkinsonism, stroke, or TBI.
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Affiliation(s)
- Wolfgang H Jost
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY.
| | - Andrzej Friedman
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Olaf Michel
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Christian Oehlwein
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Jaroslaw Slawek
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Andrzej Bogucki
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Stanislaw Ochudlo
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Marta Banach
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Fernando Pagan
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Birgit Flatau-Baqué
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - János Csikós
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Claire J Cairney
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
| | - Andrew Blitzer
- From the Parkinson-Klinik Ortenau (W.H.J.), Wolfach, Germany; Department of Neurology (A.F.), Faculty of Health Science, Medical University of Warsaw, Poland; Department of Otorhinolaryngology (O.M.), University Hospital Brussels, Vrije Universiteit Brussel, Belgium; Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation (C.O.), Gera, Germany; Department of Neurological-Psychiatric Nursing (J.S.), Medical University of Gdansk; Neurology Department (J.S.), St. Adalbert Hospital, Gdansk; Department of Extrapyramidal Diseases (A. Bogucki), Medical University of Łódź; Department of Neurology and Stroke Unit (S.O.), Medical University of Silesia, Katowice; Department of Neurology (M.B.), Collegium Medicum, Jagiellonian University, Krakow, Poland; Department of Neurology (F.P.), Georgetown University Hospital, Washington, DC; Merz Pharmaceuticals GmbH (B.F.-B., J.C.), Frankfurt am Main, Germany; Complete Medical Communications (C.J.C.), Glasgow, UK; Department of Otolaryngology/Head and Neck Surgery (A. Blitzer), Columbia University College of Physicians and Surgeons, New York; Department of Neurology (A. Blitzer), Icahn School of Medicine at Mt. Sinai, New York; and NY Center for Voice and Swallowing Disorders (A. Blitzer), New York, NY
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Onabotulinum Toxin A Injections Into the Salivary Glands for Spinal Muscle Atrophy Type I. Am J Phys Med Rehabil 2018; 97:873-878. [DOI: 10.1097/phm.0000000000000989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Niedermeyer S, Murn M, Choi PJ. Respiratory Failure in Amyotrophic Lateral Sclerosis. Chest 2018; 155:401-408. [PMID: 29990478 DOI: 10.1016/j.chest.2018.06.035] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis is a progressive neuromuscular disease characterized by both lower motor neuron and upper motor neuron dysfunction. Although clinical presentations can vary, there is no cure for ALS, and the disease is universally terminal, with most patients dying of respiratory complications. Patients die, on average, within 3 to 5 years of diagnosis, unless they choose to undergo tracheostomy, in which case, they may live, on average, 2 additional years. Up to 95% of patients with ALS in the United States choose not to undergo tracheostomy; management of respiratory failure is therefore aimed at both prolonging survival as well as improving quality of life. Standard of care for patients with ALS includes treatment from multidisciplinary teams, but many patients do not have consistent access to a pulmonary physician who regularly sees patients with this disease. The goal of this review was to serve as an overview of respiratory considerations in the management of ALS. This article discusses noninvasive ventilation in the management of respiratory muscle weakness, mechanical insufflation/exsufflation devices for airway clearance, and treatment of aspiration, including timing of placement of a percutaneous endoscopic gastrostomy tube, as well as secretion management. In addition, it is important for physicians to consider end-of-life issues such as advanced directives, hospice referral, and ventilator withdrawal.
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Affiliation(s)
- Shannon Niedermeyer
- Duke University Hospital, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Michael Murn
- Duke University Hospital, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Philip J Choi
- Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, University of Michigan Medical Center, Ann Arbor, MI.
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Restivo DA, Panebianco M, Casabona A, Lanza S, Marchese-Ragona R, Patti F, Masiero S, Biondi A, Quartarone A. Botulinum Toxin A for Sialorrhoea Associated with Neurological Disorders: Evaluation of the Relationship between Effect of Treatment and the Number of Glands Treated. Toxins (Basel) 2018; 10:toxins10020055. [PMID: 29382036 PMCID: PMC5848156 DOI: 10.3390/toxins10020055] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/22/2018] [Accepted: 01/22/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Sialorrhoea and drooling are disabling manifestations of different neurological disorders. The aim of this study was to evaluate the effects of botulinum neurotoxin type A (BoNT/A) injection on hypersalivation in 90 patients with neurological diseases of different aetiologies, and to define the minimum number of injected salivary glands to reduce sialorrhoea. Determining the minimum number of glands that need to be engaged in order to have a significant reduction in drooling may be very useful for establishing the minimum total dosage of BoNT/A that may be considered effective in the treatment of hypersalivation. Methods: Twenty-five mouse units (MU) of BoNT/A (onabotulinumtoxin A, Botox; Allergan, Irvine, CA, USA; 100 MU/2 mL, 0.9% saline; or incobotulinumtoxin A, Xeomin; Merz Pharma, Germany; 100 MU/2 mL, 0.9% saline) were percutaneously injected into the parotid (p) glands and/or submandibular (s) glands under ultrasound control. On this basis, patients were divided into three groups. In group A (30 patients), BoNT/A injections were performed into four glands; in group B (30 patients), into three glands, and in group C (30 patients), into two glands. Patients treated in three glands (group B) were divided into two subgroups based on the treated glands (2 p + 1 s = 15 patients; 2 s + 1 p = 15 patients). Similarly, patients being injected in two glands (group C) were subdivided into three groups (2 p = 10 patients; 1 p + 1 s = 10 patients; 2 s = 10 patients). In patients who were injected in three and two salivary glands, saline solution was injected into the remaining one and two glands, respectively. Assessments were performed at baseline and at 2 weeks after the injections. Results: BoNT/A significantly reduced sialorrhoea in 82 out of 90 patients. The effect was more evident in patients who had four glands injected than when three or two glands were injected. The injections into three glands were more effective than injections into two glands. Conclusions: Our results have shown that BoNT/A injections induced a significant reduction in sialorrhoea in most patients (91%). In addition, we demonstrated that sialorrhoea associated with different neurological diseases was better controlled when the number of treated glands was higher.
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Affiliation(s)
| | - Mariangela Panebianco
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool L271XF, UK.
| | - Antonino Casabona
- Department of Biomedical and Biotechnological Sciences, Section of Physiology, University of Catania, 95100 Catania, Italy.
| | - Sara Lanza
- UOC di Medicina Fisica e Riabilitazione, Comiso-Vittoria, ASP Ragusa, 97013 Ragusa, Italy.
| | | | - Francesco Patti
- DANA Department, "GF Ingrassia", Neuroscience Section-Multiple Sclerosis Center, University of Catania, 95100 Catania, Italy.
| | - Stefano Masiero
- School of Physical Medicine and Rehabilitation, University of Padua, 35121 Padua, Italy.
| | - Antonio Biondi
- Department of Surgery, University of Catania, 95100 Catania, Italy.
| | - Angelo Quartarone
- IRCCS Centro Neurolesi "Bonibo-Pulejo", via Provinciale Palermo, Contrada Casazza, 95124 Messina, Italy.
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43
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Abstract
Botulinun neurotoxin (BoNT) has emerged as one of the most multipurpose therapeutic agents in modern medicine with more clinical applications than any other drug currently on the market. Initially developed in the treatment of strabismus and neurologic movement disorders, the use of botulinun neurotoxin has been expanding during the past 3 decades to include the treatment of a variety of ophthalmologic, gastrointestinal, urologic, orthopedic, dermatologic, dental, secretory, painful, cosmetic, and other conditions. In addition to onabotulinumtoxinA (Botox), abobotulinumtoxinA (Dysport), incobotulinumtoxinA (Xeomin), and RimabotulinumtoxinB (Myobloc or NeuroBloc) there are other novel botulinun neurotoxin products currently in development. With a better understanding of the cellular mechanisms of botulinun neurotoxin and advances in biotechnology, future botulinun neurotoxin products will likely be even more effective and customized to the specific indication and tailored to the needs of the patients. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
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44
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Abstract
Changes to swallowing affect most people with Parkinson's disease (PD). Changes may not initially exercise a decisive impact, but can later pose significant threats to nutritional, hydration and respiratory health and psychosocial quality of life. This review, from a largely clinical viewpoint, outlines the nature of changes in PD and considers the issue of how many people are affected and in what ways. It outlines main approaches to assessment and management, with an emphasis on aspects relevant to PD. Dysphagia contributes to drooling in PD. The review therefore also touches on the nature and management of this condition that has its own set of health and psychosocial quality-of-life issues.
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Affiliation(s)
- Nick Miller
- Newcastle University Institute for Ageing, Speech & Language Sciences, George VI Building, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
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