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BMC Pharmacology & Toxicology Oct 2023Botulinum 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... (Meta-Analysis)
Meta-Analysis
BACKGROUND
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, Web Of Science (WOS), Scopus, Cochrane 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 I tests. We used the GRADE tool to assess the certainty of evidence (COE).
RESULTS
Eight articles involving 259 patients compared BoNT injections with a 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<0.001; 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.
TRIAL REGISTRATION
Our review protocol was registered on PROSPERO (42021288334).
Topics: Humans; Botulinum Toxins, Type A; Sialorrhea; Parkinson Disease; Dental Caries; Treatment Outcome
PubMed: 37828600
DOI: 10.1186/s40360-023-00694-7 -
Developmental Medicine and Child... May 2007A descriptive analysis was conducted on studies on the behavioural treatment of drooling (published between 1970 and 2005). The 17 articles that met the inclusion... (Review)
Review
A descriptive analysis was conducted on studies on the behavioural treatment of drooling (published between 1970 and 2005). The 17 articles that met the inclusion criteria described 53 participants (mean age 14y 7mo, [SD 4y 9mo]; range 6-28y). Sex of 87% of the participants was reported: 28 male, 18 female. For 60% of the participants the degree of learning disability was reported, varying from severe/profound (n=24, 75%), moderate (n=4, 13%), to mild (n=2, 6%), while two participants (6%) had no learning disabilities. Forty-two participants (79%) were diagnosed with cerebral palsy. Behavioural procedures included instruction, positive and negative reinforcement, overcorrection and restitution, verbal and automatic cueing, and/or self-management. Effective behavioural procedures are reported in children with and without learning disability and/or motor impairment. Even participants with profound learning disability may benefit from behavioural intervention. However, the evidence base in terms of number of studies in this area is limited. Fifteen studies used a single participant design; two studies implemented an experimental-comparison group design. Some of these studies were poorly designed and methodological flaws were identified. Therefore, conclusions about efficacy of behaviour therapy for drooling and/or best practice cannot be drawn, although our analysis suggests that this approach is promising. However, future research on this topic is needed. After years of research focused on medical treatment, the option of behavioural treatment to reduce drooling should be reconsidered in relation to the medical management of this problem.
Topics: Adolescent; Adult; Behavior Therapy; Child; Clinical Trials as Topic; Humans; Intellectual Disability; Outcome and Process Assessment, Health Care; Sialorrhea
PubMed: 17489816
DOI: 10.1111/j.1469-8749.2007.00390.x -
European Annals of Otorhinolaryngology,... Feb 2017The aim of the present study was to examine the effect of acquired unilateral peripheral facial palsy on speech, communication and oral functions and to study the...
OBJECTIVES
The aim of the present study was to examine the effect of acquired unilateral peripheral facial palsy on speech, communication and oral functions and to study the relationship between the degree of facial palsy and articulation, saliva control, eating ability and lip force.
MATERIALS AND METHODS
In this descriptive study, 27 patients (15 men and 12 women, mean age 48years) with unilateral peripheral facial palsy were included if they were graded under 70 on the Sunnybrook Facial Grading System. The assessment was carried out in connection with customary visits to the ENT Clinic and comprised lip force, articulation and intelligibility, together with perceived ability to communicate and ability to eat and control saliva conducted through self-response questionnaires.
RESULTS
The patients with unilateral facial palsy had significantly lower lip force, poorer articulation and ability to eat and control saliva compared with reference data in healthy populations. The degree of facial palsy correlated significantly with lip force but not with articulation, intelligibility, perceived communication ability or reported ability to eat and control saliva.
CONCLUSION
Acquired peripheral facial palsy may affect communication and the ability to eat and control saliva. Physicians should be aware that there is no direct correlation between the degree of facial palsy and the possible effect on communication, eating ability and saliva control. Physicians are therefore recommended to ask specific questions relating to problems with these functions during customary medical visits and offer possible intervention by a speech-language pathologist or a physiotherapist.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Articulation Disorders; Eating; Facial Paralysis; Female; Humans; Lip; Male; Middle Aged; Sialorrhea; Speech Intelligibility; Surveys and Questionnaires; Young Adult
PubMed: 27836742
DOI: 10.1016/j.anorl.2015.12.002 -
Schizophrenia Bulletin Jul 2008
Review
Topics: Antipsychotic Agents; Astemizole; China; Clozapine; Doxepin; Histamine Antagonists; Humans; Medicine, Chinese Traditional; Muscarinic Antagonists; Placebo Effect; Propantheline; Randomized Controlled Trials as Topic; Sialorrhea; Treatment Outcome
PubMed: 18495644
DOI: 10.1093/schbul/sbn043 -
Journal of Clinical Medicine Mar 2019The main objective was to assess the efficacy of botulinum toxin-based treatment for sialorrhea in adult patients with Parkinson's disease. The search was performed by... (Review)
Review
The main objective was to assess the efficacy of botulinum toxin-based treatment for sialorrhea in adult patients with Parkinson's disease. The search was performed by using the Medline-PubMed, EMBASE and Cochrane Library databases from January 2000⁻December 2017, in English/Spanish in patients with Parkinson's disease and sialorrhea. The methodological quality of trials was carried out by following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria and the Newcastle⁻Ottawa Scale (NOS). Finally, a total of 21 articles were identified as fulfilling the inclusion criteria. There is no consensus regarding the site of injection of the toxin (single or multiple points), toxin dose or follow-up period. In all cases there was a reduction of sialorrhea. Treatment safety increases with the use of ultrasonography. Effects approximately occur at one week post-injection and for 3⁻5 months. Botulinum toxin is an effective therapeutic strategy or option in treating sialorrhea in adult patients with Parkinson's disease. More studies with a better design, larger samples and a longer follow-up period are required to confirm these data.
PubMed: 30845700
DOI: 10.3390/jcm8030317 -
Journal of the American Dental... Jun 2003The authors review the clinical features, epidemiology, pathophysiology, medical management, dental findings and dental treatment of patients with alcoholism. (Review)
Review
BACKGROUND
The authors review the clinical features, epidemiology, pathophysiology, medical management, dental findings and dental treatment of patients with alcoholism.
LITERATURE REVIEWED
The authors conducted a MEDLINE search for 1995 through 2001 using the key terms of alcoholism, epidemiology, pathophysiology, treatment and dentistry. Reports selected for further review included those published in English in peer-reviewed journals. The authors gave preference to articles reporting randomized, controlled trials.
CONCLUSIONS
Alcoholism is a chronic and progressive psychiatric illness that afflicts more than 14 million Americans. It is characterized by a loss of control over the use of alcohol, resulting in impaired social functioning, and the consequent development of medical illnesses. The disease arises in genetically vulnerable people when they are overwhelmed by their cravings for the alcohol-associated euphoria that results from the actions of several neurotransmitter systems in the brain's pleasure center. New medications to counteract alcohol-induced neurotransmission imbalance may assist patients in reducing their craving.
CLINICAL IMPLICATIONS
The prevalence of dental disease usually is extensive because of a disinterest in performing appropriate oral hygiene techniques and diminished salivary flow. Concurrent abuse of tobacco products worsens dental disease and heightens the risk of developing oral cancer. Identification of the alcohol-abusing patient, a cancer-screening examination, preventive dental education, and use of saliva substitutes and anticaries agents are indicated. Special precautions must be taken when performing surgery and when prescribing or administering analgesics, antibiotics or sedative agents that are likely to have an adverse interaction with alcohol or psychiatric medications.
Topics: Alcohol Deterrents; Alcohol-Related Disorders; Dental Care for Chronically Ill; Drug Interactions; Ethanol; Hemorrhage; Humans; Liver Diseases, Alcoholic; Mandibular Fractures; Mouth Neoplasms; Nutrition Disorders; Periodontal Diseases; Sialorrhea; Smoking; Tobacco Use Disorder; Xerostomia
PubMed: 12839410
DOI: 10.14219/jada.archive.2003.0260 -
Journal of Neuromuscular Diseases 2022The knowledge about the impact of oral motor impairment in neuromuscular diseases (NMDs) is limited but increasing. (Review)
Review
BACKGROUND
The knowledge about the impact of oral motor impairment in neuromuscular diseases (NMDs) is limited but increasing.
OBJECTIVE
The aim of this review was to collect and compile knowledge on how muscle weakness in congenital or early developing NMDs directly or indirectly affects feeding, swallowing, speech and saliva control.
METHODS
A literature search was performed in PubMed from January 1, 1998, to August 31, 2021. The keywords "feeding", "dysphagia", "swallowing", "dysarthria", "speech", "drooling" and "sialorrhea" were used in combination with "paediatric neuromuscular disease" or specific diagnoses.
RESULTS
Sixty-five studies were selected for the review, 33 focused on feeding and swallowing, 11 on speech, four on a combination of feeding, swallowing, saliva control or speech and 17 general descriptions. Most of the studies reported on patients with a disorder affecting muscles. These studies show that muscle weakness and impaired motility affecting the muscles innervated by the cranial nerves may influence feeding, swallowing, and speech, and that respiratory function, general health and neurodevelopmental delay also influence these functions. Feeding impairment and breathing difficulties are common in NMDs. Lifesaving interventions such as tube feeding and ventilatory support are common in severe cases.
CONCLUSIONS
Feeding impairment, dysphagia and dysarthria are prevalent in NMDs with congenital or early age of onset. Feeding and swallowing has been studied more than speech and saliva control. More children with NMD survive thanks to new treatment options and it is therefore urgent to follow up how these therapies may impact the development of feeding, swallowing, and speech.
Topics: Child; Deglutition Disorders; Dysarthria; Enteral Nutrition; Humans; Muscle Weakness; Neuromuscular Diseases
PubMed: 35848032
DOI: 10.3233/JND-210772 -
Paediatrics & Child Health Sep 1999Although drooling may occur in healthy children under two years of age, it is commonly observed in neurologically impaired children and carries a considerable social...
Although drooling may occur in healthy children under two years of age, it is commonly observed in neurologically impaired children and carries a considerable social stigma. Drooling can be socially embarrassing, and at times may cause serious medical complications. Drooling may result from the hypersecretion of saliva or, more commonly, the impairment of swallowing. Most of the causes of drooling can be diagnosed from a history and physical examination of the patient. Laboratory investigations are usually unnecessary. Treatment should be directed at the underlying cause whenever possible. No active management is necessary for patients who have little functional and psychological impairment from their objectively mild or intermittent drooling. Treatment options for moderate and severe drooling include physiotherapy, behavioural or biofeedback modification, pharmacotherapy and surgery.
PubMed: 20212951
DOI: 10.1093/pch/4.6.406 -
Parkinsonism & Related Disorders Jan 2020Botulinum neurotoxin (BoNT) is an effective treatment for chronic sialorrhea; however, reliable and robust evidence supporting long-term efficacy and safety is lacking.... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Botulinum neurotoxin (BoNT) is an effective treatment for chronic sialorrhea; however, reliable and robust evidence supporting long-term efficacy and safety is lacking. This study investigated the efficacy and safety of repeated incobotulinumtoxinA injections for chronic sialorrhea over 64 weeks.
METHODS
Adults with sialorrhea were randomized (2:2:1) to incobotulinumtoxinA 75 U, incobotulinumtoxinA 100 U (n = 74 each), or placebo (n = 36) in the double-blind, placebo-controlled main period (NCT02091739). Eligible subjects entered the extension period and received dose-blinded incobotulinumtoxinA 75 or 100 U in three further 16±2-week injection cycles. Efficacy and safety assessments in subjects who received incobotulinumtoxinA throughout the study included unstimulated salivary flow rate (uSFR), subjects' Global Impression of Change Scale (GICS), Drooling Severity and Frequency Scale (DSFS), modified Radboud Oral Motor Inventory for Parkinson's Disease (mROMP) drooling, speech, and swallowing symptom scores, and incidence of adverse events (AEs).
RESULTS
In total, 173/184 subjects (94%) completed the main period and entered the extension period; 141 subjects received incobotulinumtoxinA 75 U (n = 69) or 100 U (n = 72) in both periods. Mean uSFR decreased consistently with repeated incobotulinumtoxinA 75 and 100 U treatment and by -0.16 and -0.17, respectively, at the end-of-study visit. Subjects' GICS, DSFS, and mROMP drooling scores also improved at all assessments. mROMP speech and swallowing scores remained stable. The most common treatment-related AEs during the extension period were dry mouth (4.4% and 11.1%) and dysphagia (1.5% and 4.2%).
CONCLUSIONS
Data support long-term efficacy and safety of repeated incobotulinumtoxinA treatment for sialorrhea, with no additional safety concerns reported over 64 weeks.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Botulinum Toxins, Type A; Brain Diseases; Chronic Disease; Double-Blind Method; Female; Humans; Male; Middle Aged; Neuromuscular Agents; Outcome Assessment, Health Care; Parkinson Disease; Prospective Studies; Sialorrhea; Time Factors; Young Adult
PubMed: 31794936
DOI: 10.1016/j.parkreldis.2019.11.024 -
Nursing Research and Practice 2012Researchers measure biomarkers as a reflection of patient health status or intervention outcomes. While blood is generally regarded as the best body fluid for evaluation...
Researchers measure biomarkers as a reflection of patient health status or intervention outcomes. While blood is generally regarded as the best body fluid for evaluation of systemic processes, substitution of saliva samples for blood would be less invasive and more convenient. The concentration of specific biomarkers may differ between blood and saliva. The objective of this study was to compare multiple biomarkers (27 cytokines) in plasma samples, passive drool saliva samples, and filter paper saliva samples in 50 healthy adults. Demographic data and three samples were obtained from each subject: saliva collected on filter paper over 1 minute, saliva collected by passive drool over 30 seconds, and venous blood (3 mL) collected by venipuncture. Cytokines were assayed using Bio-Rad multiplex suspension array technology. Descriptive statistics and pairwise correlations were used for data analysis. The sample was 52% male and 74% white. Mean age was 26 (range = 19-63 years, sd = 9.7). The most consistent and highest correlations were between the passive drool and filter paper saliva samples, although relationships were dependent on the specific biomarker. Correlations were not robust enough to support substitution of one collection method for another. There was little correlation between the plasma and passive drool saliva samples. Caution should be used in substituting saliva for blood, and relationships differ by biomarker.
PubMed: 22619709
DOI: 10.1155/2012/246178