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Expert Review of Neurotherapeutics Oct 2021Sialorrhea, also known as hypersalivation, ptyalis, or drooling, results in physical and psychosocial complications that may have a significant negative impact on... (Review)
Review
INTRODUCTION
Sialorrhea, also known as hypersalivation, ptyalis, or drooling, results in physical and psychosocial complications that may have a significant negative impact on quality of life for both the patient and their caregiver. The goal of pharmacological treatment is to reduce excessive salivary flow, while maintaining a moist and healthy oral cavity; until recently, however, few of the agents used to treat chronic sialorrhea have been approved in pediatric patients.
AREAS COVERED
This article summarizes early evidence for the use of botulinum neurotoxin A formulations in the treatment of children/adolescents with chronic sialorrhea, and findings of the recently completed phase III trial of incobotulinumtoxinA in this indication. Alternative therapies are also briefly discussed.
EXPERT OPINION
IncobotulinumtoxinA is the first botulinum neurotoxin A to be approved for the treatment of chronic sialorrhea in children and adults, following the results of phase III trials that demonstrate the efficacy and safety of the drug in these patients. The authors expect that the positive findings will result in updates to clinical guidelines for the treatment of children with chronic sialorrhea.
ABBREVIATIONS
AE, adverse event; AESI, adverse event of special interest; BoNT/A, botulinum neurotoxin A; CI, confidence interval; CP, cerebral palsy; DIS, drooling impact scale; DQ, drooling quotient; DSFS, Drooling Severity and Frequency Scale; GICS, Global Impression of Change Scale; LS, least squares; mTDS, modified Teacher's drooling scale; NR, not reported; PD, Parkinson's disease; SAE, serious adverse event; SE, standard error; SIAXI, Sialorrhea in Adults Xeomin Investigation; SIPEXI, Sialorrhea Pediatric Xeomin Investigation; SNAP-25, synaptosomal associated protein-25; TBI, traumatic brain injury; TDS, Teacher Drooling Scale; USA, United States of America; uSFR, unstimulated Salivary Flow Rate; VAS, visual analog scale.
Topics: Adolescent; Adult; Botulinum Toxins, Type A; Cerebral Palsy; Child; Humans; Quality of Life; Sialorrhea; Treatment Outcome
PubMed: 34516331
DOI: 10.1080/14737175.2021.1979959 -
Zhonghua Kou Qiang Yi Xue Za Zhi =... Feb 2007
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Oral Surgery, Oral Medicine, Oral... Jan 2006Drooling of saliva appears to be the consequence of a dysfunction in the coordination of the swallowing mechanism, resulting in excess pooling of saliva in the anterior... (Review)
Review
Drooling of saliva appears to be the consequence of a dysfunction in the coordination of the swallowing mechanism, resulting in excess pooling of saliva in the anterior portion of the oral cavity and the unintentional loss of saliva from the mouth. Drooling can produce significant negative effects on physical health and quality of life, especially in patients with chronic neurological disabilities. Various approaches to manage this condition have been described in the literature, including oral motor therapy, behavior modification via biofeedback, orofacial regulation therapy, drug therapy, radiotherapy, and surgical treatments. Minimally invasive modalities, such as injection of botulinum toxin, photocoagulation, and acupuncture, have also been reported. This article provides a comprehensive and thorough overview of drooling, with an emphasis on understanding its etiologies and modalities of treatment.
Topics: Acupuncture Therapy; Biofeedback, Psychology; Botulinum Toxins, Type A; Chorda Tympani Nerve; Humans; Laser Coagulation; Muscarinic Antagonists; Myofunctional Therapy; Nervous System Diseases; Neuromuscular Agents; Radiotherapy; Salivary Ducts; Sialorrhea
PubMed: 16360607
DOI: 10.1016/j.tripleo.2005.08.018 -
Revue Medicale Suisse Oct 201880 % of patients suffering from amyotrophic lateral sclerosis present bulbar involvement and 50 % have salivary symptoms, which are often poorly managed. They...
80 % of patients suffering from amyotrophic lateral sclerosis present bulbar involvement and 50 % have salivary symptoms, which are often poorly managed. They present either with drooling or thick secretions. This elevates the risk of bronchoaspiration leading to pneumonia, second cause of death in this population. It is hence paramount to treat, while enhancing the patient's quality of life. The first line of treatment is a salivary drying agent such as an atropine-based medication. These treatments have a low adverse effect rate, are reversible and easy to dose. Management of thick secretions is possible with mucolytics. Taking into account the severity of the bulbar involvement, the second line of treatment, once controversial, is salivary gland injections of botulinium toxin.
Topics: Amyotrophic Lateral Sclerosis; Humans; Quality of Life; Salivary Glands; Sialorrhea
PubMed: 30303328
DOI: No ID Found -
Journal of Oral Rehabilitation Sep 2000The aetiology of drooling is described alongside the alternative treatment strategies for what is a disturbing disorder for many children. The advantages and... (Review)
Review
The aetiology of drooling is described alongside the alternative treatment strategies for what is a disturbing disorder for many children. The advantages and disadvantages of each treatment modality are discussed. Conditions for optimal management are described.
Topics: Behavior Therapy; Child; Deglutition Disorders; Dental Care for Disabled; Humans; Myofunctional Therapy; Salivary Glands; Sialorrhea
PubMed: 11012847
DOI: 10.1046/j.1365-2842.2000.00575.x -
The option of sonographic guidance in Botulinum toxin injection for drooling in Parkinson's disease.Journal of Neural Transmission (Vienna,... Jan 2016Parkinson's disease is a syndrome that frequently includes drooling, i.e., the involuntary spillage of saliva over the lip margin. Such drooling places a severe burden... (Review)
Review
Parkinson's disease is a syndrome that frequently includes drooling, i.e., the involuntary spillage of saliva over the lip margin. Such drooling places a severe burden on both the health and the quality of life of Parkinsonian patients. Its origin lies in the impairment of oral motor control and swallowing associated with Parkinson's disease. It can be treated surgically or conservatively by reducing the production of saliva in the salivary glands, to which the parotid and submandibular glands make the greatest contribution. Botulinum neurotoxins A and B, administered to these glands, are in increasing use as treatment for drooling from various causes including Parkinson's disease. Wide knowledge was gathered about preferred drugs, dosages, injection sites and injection-guiding techniques, albeit without providing evidence-based guidance or a clear rationale for the mode of action of the medication or any information about further influential or predictive factors for safety and efficacy. However, it is essential that the relevant glands be targeted accurately; although this can be done by using anatomical landmarks, the use of sonographic guidance seems preferable. In the hands of a trained injector, sonography is a quick and non-invasive imaging technique.
Topics: Botulinum Toxins; Humans; Neurotoxins; Parkinson Disease; Sialorrhea; Ultrasonography, Doppler, Transcranial
PubMed: 26138438
DOI: 10.1007/s00702-015-1416-2 -
Journal of Clinical PsychopharmacologyAntipsychotic-associated sialorrhea is a problematic adverse effect with potentially negative consequences on quality of life and medication adherence. While clozapine... (Review)
Review
PURPOSE/BACKGROUND
Antipsychotic-associated sialorrhea is a problematic adverse effect with potentially negative consequences on quality of life and medication adherence. While clozapine is the antipsychotic that is most associated with sialorrhea, there have been published reports of other second-generation antipsychotics associated with sialorrhea, including aripiprazole, olanzapine, quetiapine, and risperidone. Although drooling is mentioned within the package insert for paliperidone, to date there have been minimal published reports in which paliperidone is implicated as the offending agent.
METHODS/PROCEDURES
Here, we present a case of sialorrhea in a 56-year-old man with schizoaffective disorder who had a supratherapeutic paliperidone level after both oral and intramuscular paliperidone use.
FINDINGS/RESULTS
Paliperidone was ultimately cross tapered to aripiprazole, and the patient was given atropine drops and benztropine with resolution of the sialorrhea. We provide a review of the literature regarding the other available reports of paliperidone-associated sialorrhea, possible mechanisms behind pathophysiology, as well as reports from the World Health Organization and Food and Drug Administration adverse event reporting systems.
IMPLICATIONS/CONCLUSIONS
Clinicians should be aware of the potential for paliperidone and other nonclozapine second-generation antipsychotics to be associated with sialorrhea, especially given the increased frequency of their use for a variety of psychiatric disorders.
Topics: Antipsychotic Agents; Aripiprazole; Benzodiazepines; Humans; Male; Middle Aged; Paliperidone Palmitate; Quality of Life; Sialorrhea
PubMed: 35943409
DOI: 10.1097/JCP.0000000000001588 -
Paediatric Drugs Aug 2012Chronic drooling (sialorrhea) is a common dysfunction in children with neurologic disorders such as cerebral palsy. Glycopyrrolate oral solution, an anticholinergic... (Review)
Review
Chronic drooling (sialorrhea) is a common dysfunction in children with neurologic disorders such as cerebral palsy. Glycopyrrolate oral solution, an anticholinergic agent, is the first drug treatment approved in the US for drooling in children with neurologic conditions. This article reviews the clinical efficacy and tolerability of glycopyrrolate oral solution in pediatric patients with neurologic conditions and provides an overview of the pharmacological properties of the drug. In a phase III, randomized, double-blind, multicenter trial, children (aged 3-16 years; n = 36) with problem drooling associated with neurologic conditions and receiving glycopyrrolate oral solution had a significantly (p < 0.01) greater modified Teacher's Drooling Scale (mTDS) response rate at 8 weeks (primary endpoint) than those receiving placebo (73.7% vs 17.6%). At 24 weeks in an additional, noncomparative, phase III study, 52.3% of glycopyrrolate oral solution recipients (aged 3-18 years; n = 137) had an mTDS response (primary endpoint); the response rate was consistently above 50% at all 4-weekly timepoints, aside from the first assessment at week 4 (40.3%). In general, glycopyrrolate oral solution was well tolerated in clinical trials. The majority of adverse events were within expectations as characteristic anticholinergic outcomes.
Topics: Administration, Oral; Adolescent; Cerebral Palsy; Child; Chronic Disease; Clinical Trials as Topic; Glycopyrrolate; Humans; Muscarinic Antagonists; Sialorrhea; Solutions
PubMed: 22646067
DOI: 10.2165/11208120-000000000-00000 -
Developmental Medicine and Child... Feb 1988
Topics: Cerebral Palsy; Humans; Sialorrhea
PubMed: 3371566
DOI: 10.1111/j.1469-8749.1988.tb04738.x -
The Journal of Laryngology and Otology Nov 1985The drooling that accompanies motor neurone disorders adds to the burden of an individual already severely handicapped socially. Control of this problem can be achieved...
The drooling that accompanies motor neurone disorders adds to the burden of an individual already severely handicapped socially. Control of this problem can be achieved by a number of measures, such as the surgical repositioning of the salivary gland ducts and by use of medical or surgical means of reducing salivary production. Nineteen patients aged 5 to 9 years, with excessive drooling as a result of perinatal brain damage, have been treated surgically at Groote Schuur Hospital, Cape Town, by bilateral tympanic neurectomies, unilateral chorda tympani nerve section and contralateral submandibular gland excision. In all 19, salivary flow was reduced and the drooling problem significantly improved. No post-operative complications occurred.
Topics: Adolescent; Adult; Cerebral Palsy; Child; Child, Preschool; Chorda Tympani Nerve; Ear, Middle; Female; Humans; Male; Sialorrhea; Submandibular Gland; Tympanic Membrane
PubMed: 4056596
DOI: 10.1017/s0022215100098261