Sialorrhea

The Challenges Faced and Lessons Learnt in the Multidisciplinary Management of Medication Refractory Post-Stroke Sialorrhea: A Case Report

“…Although the prevalence of sialorrhea in stroke has not been well-documented, it can lead to medical, psychological, and social complications in stroke patients [4]. The key to the treatment of sialorrhea is multidisciplinary management by a team of specialists that would ideally include a rehabilitation medicine physician, speech therapist, occupational therapist, physiotherapist, otolaryngologist, neurologist, palliative medicine specialist, and radiation specialist [1,3,4].…”

“…The SCS-PD consists of a 0-3 point rating scale of seven questions covering the severity, frequency, and feeling of discomfort during day-time, night-time, eating, speaking, and social participation [8]. Table 1 Currently, there is no consensus as to which subjective scale is the standardized measure, and none of them have been validated in post-stroke patients [1]. As the treatment of sialorrhea aims to improve QOL of the affected patients and their families, a 1990 consortium on the management of sialorrhea concluded that objective quantification of sialorrhea was not required to determine treatment effectiveness [1].…”

“…Table 1 Currently, there is no consensus as to which subjective scale is the standardized measure, and none of them have been validated in post-stroke patients [1]. As the treatment of sialorrhea aims to improve QOL of the affected patients and their families, a 1990 consortium on the management of sialorrhea concluded that objective quantification of sialorrhea was not required to determine treatment effectiveness [1]. For our patient, we assessed the symptom control by reviewing her history of daily use of the number of cotton gauzes and assessing her DRS score.…”

“…Non-pharmacological treatment includes behavioral modification, use of oral appliances, and multidisciplinary rehabilitation using occupational, physical, and speech therapy to improve head control and muscle tone [1]. Pharmacological treatment consists primarily of anticholinergic medications, which include atropine, scopolamine (hyoscine), glycopyrrolate, and a tricyclic antidepressant (amitriptyline, nortriptyline) and/or BoNT salivary gland injection.…”

“…Sialorrhea is defined as the involuntary flow of saliva beyond the lip margin [1]. The most common cause of post-stroke sialorrhea is related to the neurological impairment that involves either an inability to retain saliva within the mouth secondary to poor orofacial muscular control and/or dysphagia leading to excess pooling of saliva in the anterior oral cavity [2,3].…”