Treatment for sialorrhea (excessive saliva) in people with motor neuron disease/amyotrophic lateral sclerosis

Abstract

There is some evidence for use of botulinum toxin injections to salivary glands for the treatment of sialorrhea in MND. Further research is required on this important symptom. Data are needed on the problem of sialorrhea in MND and its measurement, both by patient self report measures and objective tests. These will allow the development of better randomized controlled trials.

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

“…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.…”

“…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.…”

“…It has been estimated that 50% of ALS patients suffer from problematic oral secretions and a recent survey of clinicians estimated that in 42% of patients with secretion problems, these problems are poorly controlled [2].Symptoms and consequences include drooling (sialorrhoea), breakdown of the skin around the mouth, speech disturbance, disruption of sleep, coughing and a higher risk of aspiration. These problems can lead to psychosocial symptoms including distress, embarrassment and social withdrawal [3,4].…”

Efficacy of Incobotulinumtoxin Type A (Xeomin®) in the Management of Sialorrhea in Neurodegenerative Diseases

“…This significant efficacy was obtained by a non-invasive treatment and a method of administration that thanks to ultra-sound guidance minimizes the risk of iatrogenic injuries, as the loss of the facial nerve [21].…”

Long-Term Mechanical Ventilation: Management Strategies

“…In some instances, additional measures to reduce secretions are worth attempting, such as scopolamine patches 64 or parotid gland injection with botulinum toxin. 65 Once patients start to tolerate SBTs, a one way speaking valve 66 can be used to allow phonation over the vocal cords and also enhance swallowing by augmenting subglottic pressure. In patients who cannot wean from MV these devices can theoretically be used "in line" to allow speech in mechanically ventilated patients.…”