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Sialorrhea in patients with ALS: current treatment options.

Abstract

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder of the motor neuron, which selectively affects it both at central (first motor-neuron) and peripheral level (second motor-neuron). The disease shows up at a mean age of 56 years and the most affected are males. Although ALS may start as a bulbar or spinal disease, with the progression of the disease typically both become evident. Pharmacological approved treatments for ALS are still limited and include riluzole and edaravone which improve survival over time. Despite this, ALS leads to progressive muscle involvement and requires a complex multidisciplinary approach to manage increasing disability which goes beyond motor neurons. Sialorrhea is, amongst others, one of the most disabling symptoms in ALS. The complexity in managing saliva is due to a muscular spasticity and to a scarce palatino-lingual muscles control, rather than to an overproduction of saliva. These features could increase the risk of aspiration pneumonia and limit the use of noninvasive mechanical ventilation. We reviewed the treatment for sialorrhea in ALS patients that are available at this time, emphasizing pros and cons for each approach. Our purpose is to create a practical tool for the diagnosis, in order to facilitate the quantification and management of sialorrhea in everyday practice.

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  • Authors+Show Affiliations

    ,

    Pneumology Unit, Santa Maria Bianca Hospital, Mirandola, AUSL Modena, Modena, Italy.

    ,

    Respiratory Unit, Neuromuscular OmniCentre (NeMO), Neurorehabilitation, University of Milan, Niguarda Hospital, Milan, Italy.

    ,

    Pneumology Unit, Santa Maria Bianca Hospital, Mirandola, AUSL Modena, Modena, Italy.

    Neuromuscular Omnicentre (NeMO), Neurorehabilitation, University of Milan, Niguarda Hospital, Milan, Italy.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31118868

    Citation

    Garuti, Giancarlo, et al. "Sialorrhea in Patients With ALS: Current Treatment Options." Degenerative Neurological and Neuromuscular Disease, vol. 9, 2019, pp. 19-26.
    Garuti G, Rao F, Ribuffo V, et al. Sialorrhea in patients with ALS: current treatment options. Degener Neurol Neuromuscul Dis. 2019;9:19-26.
    Garuti, G., Rao, F., Ribuffo, V., & Sansone, V. A. (2019). Sialorrhea in patients with ALS: current treatment options. Degenerative Neurological and Neuromuscular Disease, 9, pp. 19-26. doi:10.2147/DNND.S168353.
    Garuti G, et al. Sialorrhea in Patients With ALS: Current Treatment Options. Degener Neurol Neuromuscul Dis. 2019;9:19-26. PubMed PMID: 31118868.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Sialorrhea in patients with ALS: current treatment options. AU - Garuti,Giancarlo, AU - Rao,Fabrizio, AU - Ribuffo,Viviana, AU - Sansone,Valeria A, Y1 - 2019/03/20/ PY - 2019/5/24/entrez PY - 2019/5/24/pubmed PY - 2019/5/24/medline KW - amyotrophic lateral sclerosis KW - anticholinergic drug KW - botulinum toxin KW - radiotherapy salivary gland KW - sialorrhea SP - 19 EP - 26 JF - Degenerative neurological and neuromuscular disease JO - Degener Neurol Neuromuscul Dis VL - 9 N2 - Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder of the motor neuron, which selectively affects it both at central (first motor-neuron) and peripheral level (second motor-neuron). The disease shows up at a mean age of 56 years and the most affected are males. Although ALS may start as a bulbar or spinal disease, with the progression of the disease typically both become evident. Pharmacological approved treatments for ALS are still limited and include riluzole and edaravone which improve survival over time. Despite this, ALS leads to progressive muscle involvement and requires a complex multidisciplinary approach to manage increasing disability which goes beyond motor neurons. Sialorrhea is, amongst others, one of the most disabling symptoms in ALS. The complexity in managing saliva is due to a muscular spasticity and to a scarce palatino-lingual muscles control, rather than to an overproduction of saliva. These features could increase the risk of aspiration pneumonia and limit the use of noninvasive mechanical ventilation. We reviewed the treatment for sialorrhea in ALS patients that are available at this time, emphasizing pros and cons for each approach. Our purpose is to create a practical tool for the diagnosis, in order to facilitate the quantification and management of sialorrhea in everyday practice. SN - 1179-9900 UR - https://www.unboundmedicine.com/medline/citation/31118868/Sialorrhea_in_patients_with_ALS:_current_treatment_options L2 - https://dx.doi.org/10.2147/DNND.S168353 DB - PRIME DP - Unbound Medicine ER -