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Clinical Oral Investigations Jun 2023The present systematic review and network meta-analysis of randomized control trials (RCTs) aimed to establish whether there are evidence-based differences in the... (Meta-Analysis)
Meta-Analysis Review
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 Unpublished trials were searched on clinicaltrials.gov and the Brazilian Clinical Trials Registry.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.
Topics: Humans; Sialorrhea; Parkinson Disease; Network Meta-Analysis; Botulinum Toxins, Type A; Glycopyrrolate
PubMed: 37036514
DOI: 10.1007/s00784-023-04981-9 -
Expert Review of Neurotherapeutics Feb 2021: Drooling represents a major problem in the every-day life of pediatric patients with neurological disorders. The significant burden, both physical and... (Review)
Review
: 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. : 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. : 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.
Topics: Cerebral Palsy; Child; Humans; Nervous System Diseases; Sialorrhea; Treatment Outcome
PubMed: 33222543
DOI: 10.1080/14737175.2021.1855146 -
Hospital & Community Psychiatry Nov 1991
Topics: Clozapine; Humans; Male; Middle Aged; Schizophrenia; Sialorrhea
PubMed: 1743654
DOI: 10.1176/ps.42.11.1174 -
International Journal of Medical... 2015Salivary secretory disorders can be the result of a wide range of factors. Their prevalence and negative effects on the patient's quality of life oblige the clinician to... (Review)
Review
BACKGROUND
Salivary secretory disorders can be the result of a wide range of factors. Their prevalence and negative effects on the patient's quality of life oblige the clinician to confront the issue.
AIM
To review the salivary secretory disorders, inducing drugs and their clinical management.
METHODS
In this article, a literature search of these dysfunctions was conducted with the assistance of a research librarian in the MEDLINE/PubMed Database.
RESULTS
Xerostomia, or dry mouth syndrome, can be caused by medication, systemic diseases such as Sjögren's Syndrome, glandular pathologies, and radiotherapy of the head and neck. Treatment of dry mouth is aimed at both minimizing its symptoms and preventing oral complications with the employment of sialogogues and topical acting substances. Sialorrhea and drooling, are mainly due to medication or neurological systemic disease. There are various therapeutic, pharmacologic, and surgical alternatives for its management. The pharmacology of most of the substances employed for the treatment of salivary disorders is well-known. Nevertheless, in some cases a significant improvement in salivary function has not been observed after their administration.
CONCLUSION
At present, there are numerous frequently prescribed drugs whose unwanted effects include some kind of salivary disorder. In addition, the differing pathologic mechanisms, and the great variety of existing treatments hinder the clinical management of these patients. The authors have designed an algorithm to facilitate the decision making process when physicians, oral surgeons, or dentists face these salivary dysfunctions.
Topics: Humans; Radiotherapy; Sialorrhea; Xerostomia
PubMed: 26516310
DOI: 10.7150/ijms.12912 -
Expert Review of Neurotherapeutics Feb 2012The involvement of the autonomic nervous system in Parkinson's disease causes many non-motor symptoms, among which gastrointestinal complaints are prominent. Drooling,... (Review)
Review
The involvement of the autonomic nervous system in Parkinson's disease causes many non-motor symptoms, among which gastrointestinal complaints are prominent. Drooling, dyspepsia, constipation, abdominal pain and fecal incontinence are frequently a source of patient distress. Dysphagia is recognized as causing both discomfort and increased risk of serious complications. Although a diagnosis can often be established based on the reports of patients and/or caregivers, and additional testing is seldom required, these diagnoses are clearly under recognized in clinical practice. These symptoms respond to the same treatment measures used in the general population, although certain drugs with a potential to increase parkinsonian symptoms should be avoided. Increased and early identification of these symptoms can result in a significant improvement in the quality of life of Parkinson's disease patients.
Topics: Autonomic Nervous System; Constipation; Deglutition Disorders; Gastrointestinal Diseases; Gastrointestinal Tract; Humans; Parkinson Disease; Sialorrhea
PubMed: 22288679
DOI: 10.1586/ern.11.192 -
The American Journal of Gastroenterology Oct 1995Dysphagia and drooling of saliva are frequent symptoms in Parkinson's disease (PD), occurring in one-half and three-quarters of all patients, respectively. Aspiration... (Review)
Review
Dysphagia and drooling of saliva are frequent symptoms in Parkinson's disease (PD), occurring in one-half and three-quarters of all patients, respectively. Aspiration related to swallowing is a major cause of morbidity and mortality in PD. Defects in oral, pharyngeal, and esophageal phases of swallowing have been documented in patients with PD, and these defects precede symptoms. This paper reviews the current knowledge concerning swallowing abnormalities in PD. The pathogenesis of dysphagia and drooling of saliva is multifactorial, involving cognitive and psychological changes in addition to abnormalities of the extrapyramidal and autonomic nervous systems. Videofluoroscopic imaging of the upper esophageal sphincter and pharynx during mastication and swallowing has been the basis of our understanding of the mechanical malfunction present in patients with PD. Manometric abnormalities of the esophageal body and lower esophageal sphincter have also been documented. The use of combined manofluoroscopy to examine the upper esophageal sphincter and pharynx in PD offers great promise both in understanding the defects and directing therapy. Voluntary airway protection techniques may reduce aspiration, but they need to be tested in a clinical study. Such maneuvers may reduce the morbidity seen in PD.
Topics: Deglutition; Deglutition Disorders; Esophagus; Gastroesophageal Reflux; Humans; Parkinson Disease; Pharynx; Sialorrhea
PubMed: 7572887
DOI: No ID Found -
Nederlands Tijdschrift Voor Geneeskunde 2010Between 50% and 60% of patients with parkinsonism suffer from severe drooling (sialorrhoea). Sialorrhoea is a major social problem with medical risks as well, e.g.... (Review)
Review
Between 50% and 60% of patients with parkinsonism suffer from severe drooling (sialorrhoea). Sialorrhoea is a major social problem with medical risks as well, e.g. aspiration pneumonia. Sialorrhoea is not caused by increased production of saliva, but by impaired swallowing, leading to storage of saliva in the anterior part of the mouth. Sialorrhoea can be treated by anticholinergics, botulinum toxin injections, surgery and radiotherapy of the salivary glands. The optimal treatment of sialorrhoea needs to be determined individually, for which a decision tree is available.
Topics: Botulinum Toxins, Type A; Cholinergic Antagonists; Humans; Parkinson Disease; Patient Selection; Pneumonia, Aspiration; Sialorrhea; Treatment Outcome
PubMed: 21083950
DOI: No ID Found -
Journal of Pain and Symptom Management Apr 2022Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative motor neuron disease (MND), and sialorrhea is a known symptom in patients with ALS, which may cause a... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVES
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative motor neuron disease (MND), and sialorrhea is a known symptom in patients with ALS, which may cause a social embarrassment and discomfort. However, people do not pay attention to sialorrhea up to now. This study is aimed at conducting a systematic review and meta-analysis of the pooled prevalence of sialorrhea in ALS patients all around the world and raising awareness of salivation.
METHODS
We searched PubMed and EMBASE databases to obtain the comprehensive literatures which reported the prevalence of sialorrhea. We used AHRQ and NOS to evaluate the literature quality. Subgroup analyses were performed based on screening instruments and severity of sialorrhea. At the meantime, sensitivity analyses was also conducted to identify the source of heterogeneity.
RESULTS
A total of 17 eligible studies which included 21 groups of data reported prevalence of sialorrhea. The pooled prevalence of sialorrhea among ALS patients was 30.8% (95% CI: 20.0%-44.2%). For studies using ALSFRS-R, direct questioning, postal survey, and ALSSoL average and ALSFRS-R, the pooled prevalence of sialorrhea was 22.7%, 25.8%, 29.8% and 52.0% respectively. According to the severity of sialorrhea, the prevalence of mild, moderate, and severe sialorrhea were 25.1%, 11.2%, and 10.5%, respectively. And none of the studies alone had a significant effect on the overall prevalence of sialorrhea after we eliminated each study separately in sensitivity analyses.
CONCLUSIONS
Sialorrhea is a relatively common symptom in ALS patients with a comparatively high prevalence. In our study, we found that the prevalence of sialorrhea in ALS patients is relatively higher than the results based on direct questioning or postal survey. Therefore, we deduced that sialorrhea should be evaluated by more complex professional assessment scales to improve the quality of life and improve early prognosis of disease.
Topics: Amyotrophic Lateral Sclerosis; Humans; Prevalence; Quality of Life; Salivation; Sialorrhea
PubMed: 34920148
DOI: 10.1016/j.jpainsymman.2021.12.005 -
International Journal of Palliative... Nov 2010Drooling is a common and potentially distressing symptom in those with motor neurone disease. A coordinated multidisciplinary approach is required to optimally manage... (Review)
Review
Drooling is a common and potentially distressing symptom in those with motor neurone disease. A coordinated multidisciplinary approach is required to optimally manage this symptom. Both pharmacological and non-pharmacological strategies are required, and when drugs are used, off-label prescribing in terms of indication or route of administration is common. Further research needs to explore ways of enhancing swallowing ability as well as ways of optimizing drug therapies.
Topics: Amyotrophic Lateral Sclerosis; Botulinum Toxins; Humans; Muscarinic Antagonists; Nursing Assessment; Sialorrhea
PubMed: 21135790
DOI: 10.12968/ijpn.2010.16.11.80024 -
The Cochrane Database of Systematic... Feb 2012Drooling is a common problem for children with cerebral palsy (CP). This can be distressing for these children as well as for their parents and caregivers. The... (Review)
Review
BACKGROUND
Drooling is a common problem for children with cerebral palsy (CP). This can be distressing for these children as well as for their parents and caregivers. The consequences of drooling include risk of social rejection, damp and soiled clothing, unpleasant odour, irritated chapped skin, mouth infections, dehydration, interference with speech, damage to books, communication aids, computers, and the risk of social isolation (Blasco 1992; Van der Burg 2006). A range of interventions exist that aim to reduce or eliminate drooling. There is a lack of consensus regarding which interventions are most effective for children with CP.
OBJECTIVES
(1) To evaluate the effectiveness and safety of interventions aimed at reducing or eliminating drooling in children with cerebral palsy. (2) To provide the best available evidence to inform clinical practice. (3) To assist with future research planning.
SEARCH METHODS
We searched the following databases from inception to December 2010 : Cochrane Central Register of Controlled Trials (CENTRAL); Medline via Ovid; EMBASE; CINAHL; ERIC; Psych INFO; Web of Science; Web of Knowledge; AMED; SCOPUS; Dissertation Abstracts.We searched for ongoing clinical trials in the Clinical Trials web site (http://clinicaltrials.gov.) and in the Current Controlled Trials web site (http://www.controlled-trials.com/). We hand searched a range of relevant journals and conference proceeding abstracts.
SELECTION CRITERIA
Only randomised controlled trials (RCTs) and controlled clinical trials (CCTs) were included.
DATA COLLECTION AND ANALYSIS
Data were extracted independently by MW, MS and LP and differences resolved through discussion.
MAIN RESULTS
Six studies were eligible for inclusion in the review. Four of these studies were trials using botulinum toxin-A (BoNT-A) and two were trials on the pharmacological interventions, benztropine and glycopyrrolate. No RCTs or CCTs were retrieved on surgery, physical, oro-motor and oro-sensory therapies, behavioural interventions, intra-oral appliances or acupuncture. In the studies eligible for review, there was considerable heterogeneity within and across interventions and a meta-analysis was not possible. A descriptive summary of each study is provided. All studies showed some statistically significant change for treatment groups up to 1 month post intervention. However, there were methodological flaws associated with all six studies.
AUTHORS' CONCLUSIONS
It was not possible to reach a conclusion on the effectiveness and safety of either BoNT-A or the pharmaceutical interventions, benztropine and glycopyrrolate. There is insufficient evidence to inform clinical practice on interventions for drooling in children with CP. Directions for future research are provided.
Topics: Adolescent; Adult; Benztropine; Botulinum Toxins, Type A; Cerebral Palsy; Child; Child, Preschool; Female; Glycopyrrolate; Humans; Infant; Male; Neuromuscular Agents; Randomized Controlled Trials as Topic; Salivation; Sialorrhea; Young Adult
PubMed: 22336850
DOI: 10.1002/14651858.CD008624.pub2