Pathophysiology and Symptomatology of Drooling in Parkinson’s Disease

Polychronis, Sotirios; Nasios, Grigorios; Dardiotis, Efthimios; Messinis, Lambros; Pagano, Gennaro

doi:10.3390/healthcare10030516

Cited by 5 publications

(3 citation statements)

References 64 publications

(162 reference statements)

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“…Sialorrhea was originally regarded as a parkinsonian symptom resulting from the decreased motility of the esophagus due to bradykinesia of the laryngeal muscle in the era of first‐generation antipsychotics (Srivanitchapoom et al., 2014). Recent reviews have shown that the exact pathophysiological mechanism for developing sialorrhea in Parkinson's disease is not yet fully understood; it is likely not due to a single factor that is limited to the nigrostriatal dopamine pathway, but rather to a mixture of factors (Polychronis et al., 2022).…”

Section: Discussionmentioning

confidence: 99%

The factor structure of extrapyramidal symptoms evaluated using the Drug‐Induced Extrapyramidal Symptoms Scale in patients with schizophrenia: Results from the 2016 REAP AP‐4 study

Kubota

Inada

Lin

et al. 2022

Human Psychopharmacology

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Introduction Drug‐induced extrapyramidal syndrome (EPS) remains a major problem in clinical psychiatry. This study aimed to examine the factor structure of drug‐induced extrapyramidal symptoms observed in patients with schizophrenia and assessed using the Drug‐Induced Extrapyramidal Symptoms Scale (DIEPSS). Methods The participants were 1478 patients with a diagnosis of schizophrenia whose EPS was assessed using the DIEPSS in India, Indonesia, Japan, Malaysia, and Taiwan in the 2016 REAP AP‐4 study. The records of the participants were randomly divided into two subgroups: the first for exploratory factor analysis of the eight DIEPSS items, and the second for confirmatory factor analysis. Results The factor analysis identified three factors: F1 (gait and bradykinesia), F2 (muscle rigidity and tremor), and F3 (sialorrhea, akathisia, dystonia, and dyskinesia). Conclusion The results suggest that the eight individual items of the DIEPSS could be composed of three different mechanisms: acute parkinsonism observed during action (F1), acute parkinsonism observed at rest (F2), and central dopaminergic mechanisms with pathophysiology other than acute parkinsonism (F3).

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Section: Discussionmentioning

confidence: 99%

The factor structure of extrapyramidal symptoms evaluated using the Drug‐Induced Extrapyramidal Symptoms Scale in patients with schizophrenia: Results from the 2016 REAP AP‐4 study

Kubota

Inada

Lin

et al. 2022

Human Psychopharmacology

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“…We initially thought that Parkinson's patients had excessive salivary production, but studies have found that Parkinson's patients have less salivary production than normal people [28][29][30]. Sialorrhea can be caused by excessive salivation, di culty swallowing, or both [29,31]. Some studies have shown that sialorrhea is thought to be due to dysphagia that reduces the effective removal of saliva rather than excessive drooling [32].…”

Section: Introductionmentioning

confidence: 99%

The effectiveness and safety of botulinum toxin injections for the treatment of sialorrhea with Parkinson’s disease: A systematic review and meta-analysis

Yang

Huang

Tan

et al. 2022

Preprint

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Objectives 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, WOS, Scopus, 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 method to assess the certainty of evidence (COE). Results Eight articles involving 259 patients compared BoNT injections with 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 < 0.00001; 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. Registration Our review protocol was registered on PROSPERO (42021288334).

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“…In a review article, Polychronis et al critically approached the relevant literature of drooling in patients with Parkinson's disease (PD), and the possible relationship between excessive drooling and other clinical manifestations of PD, such as cognitive impairment, sleep difficulties, autonomic dysfunction, constipation, and orthostatic hypotension [15]. The study concluded that excessive drooling in PD patients is due to a wide range of factors.…”

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confidence: 99%