A Review of Options for Treating Sialorrhea in Amyotrophic Lateral Sclerosis

Banfi, Paolo; Ticozzi, Nicola; Lax, Agata; Guidugli, Giulia Andrea; Nicolini, Antonello; Silani, Vincenzo

doi:10.4187/respcare.02856

Cited by 64 publications

(43 citation statements)

References 67 publications

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“…In line with the limited available recommendations for saliva management, clinicians primarily chose botulinum toxin to treat patients with symptoms inadequately controlled by anticholinergic treatment [5,19]. The 57% rates of symptomatic improvement reported in this study support the use of this treatment in such patients.…”

Section: Discussionmentioning

confidence: 81%

“…Side effects were reported in 54% of such patients, a rate similar to that seen overall with anticholinergics. The switching and combination of anticholinergics was common place in this study, but is not well discussed in the literature and deserves further exploration [3,6,19]. It would also be useful to identify the common factors in patients who do not respond well or are intolerant to anticholinergics.…”

Section: Discussionmentioning

confidence: 99%

“…Despite remaining relatively unaddressed in many reviews and guideline articles [3,6,5,19], the use of conservative measures was often reported as part of the management for both thick and thin secretions. These are largely simple interventions which can be considered at the early stages of a secretion problem.…”

Section: Discussionmentioning

confidence: 99%

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A multicentre evaluation of oropharyngeal secretion management practices in amyotrophic lateral sclerosis

McGeachan

Hobson

Al‐Chalabi

et al. 2016

Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration

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Objective: Failure to clear oral secretions can be debilitating for patients with amyotrophic lateral sclerosis, ALS, but the treatment of this symptom is poorly defined and there is no consensus on best practice. The objective of this study was to identify the treatments that are commonly prescribed, and to describe how experienced clinicians manage a patient with treatment resistant symptoms.Methods: Twenty-three clinicians were approached, of which 19 from 16 centres across the UK provided case report forms for a total of 119 ALS patients identified as having problematic oral secretions.Results: The use of five anticholinergics, salivary gland botulinum toxin injections, conservative management approaches and carbocisteine were reported. Of the 72 patients who were evaluated following the initiation of a first anticholinergic, 61% had symptomatic improvement. Only 19% of patients achieved symptomatic improvement with the use of an alternative anticholinergic when an initial anticholinergic achieved no symptomatic improvement. Problems with thick and thin secretions often co-existed with 37% of patients receiving treatment for both types of problem.Conclusion: A variety of treatment options are employed by expert clinicians for problematic oral secretions in ALS patients. The variation in management highlights the need for further prospective research in this area.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A multicentre evaluation of oropharyngeal secretion management practices in amyotrophic lateral sclerosis

McGeachan

Hobson

Al‐Chalabi

et al. 2016

Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration

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“…Transdermal application of hyoscyamine or scopolamine has the advantage of a constant concentration of drug in the circulation. 100 For patients with sialorrhea refractory to medical therapy, salivatory gland botulinum toxin injections are an option, which lead to a significant decrease in saliva volume 101 and have been shown to improve quality of life. 102 Another alternative for treatment of refractory sialorrhea is radiation therapy of salivary glands.…”

Section: Sialorrheamentioning

confidence: 99%

Amyotrophic lateral sclerosis: clinical perspectives

Haringer¹,

Gibson²

2015

ODRR

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Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease in adults. It is a rapidly advancing neurodegenerative disease leading to progressive paralysis and death, with a mean time of survival from onset of symptoms to death of 2-5 years. The pathophysiology of ALS remains poorly understood. The only US Food and Drug Administration-approved therapy for ALS is riluzole, a glutamatergic neurotransmission inhibitor, with modest benefits on survival. Many other agents have shown promising results in preclinical trials, but have yet to show benefit in human clinical trials. This review gives an overview of drugs that have been studied in clinical trials and their reported outcomes. This also includes more recent treatment strategies, including antisense oligonucleotides (ASOs) and stem cells. ASOs have the potential to target genes known to cause ALS by silencing their function. Many clinical trials are under way using these therapies. Different kinds of stem cells have been used in an attempt to either replace the lost motor neurons or to improve their metabolic supply and thus prolong their death. Given the limited therapeutic treatment options to date, the most important approach to improve the patient's quality of life remains symptom-based management. Additionally, we give an overview of the current treatment offered in multidisciplinary clinics.

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“…Management can be conservative or more invasive. Medical therapy makes use of anticholinergic drugs [12]. Glycopyrrolate and transdermal scopolamine are very available in the treatment of sialorrhea but have also a lot of side effects (tachycardia, urinary retention, confused view, instability, daze).…”

Section: Introductionmentioning

confidence: 99%