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The burden of sialorrhoea in chronic neurological conditions: current treatment options and the role of incobotulinumtoxinA (Xeomin®).
Ther Adv Neurol Disord. 2019; 12:1756286419888601.TA

Abstract

Sialorrhoea is a frequent symptom of neurological diseases (e.g. Parkinson's disease, motor neuron disease, cerebral palsy, and stroke) and is defined as excessive saliva accumulation leading to unintentional loss of saliva from the mouth. Sialorrhoea increases the overall burden on the patient and their caregivers, the impact of which can be both physical and psychosocial. Treatments for sialorrhoea range from lifestyle and behavioural guidance, to medications, surgery or radiation. Nonpharmacological interventions include advice on posture, swallowing control, cough management, dietary changes, eating and drinking techniques, and behavioural modification; however, these conservative measures may be ineffective for people with progressive neurological conditions. The pharmacological treatment of sialorrhoea is challenging because medications licensed for this purpose are limited, but treatments can include anticholinergic drugs and botulinum toxins. Surgical treatment of sialorrhoea is typically reserved as a last resort for patients. IncobotulinumtoxinA (Xeomin®) is the first botulinum toxin type A to receive US and UK marketing authorization for the symptomatic treatment of chronic sialorrhoea due to neurological disorders in adults. In this review, we discuss and compare the frequency and method of administration, location of treatment delivery, approximate annual costs and main side effects of botulinum toxin and different anticholinergic drugs. Management of patients with chronic neurological conditions requires input from multiple specialist teams and thus a multidisciplinary team (MDT) approach is considered fundamental to ensure that care is consistent and tailored to patients' needs. To ensure that adult patients with neurological conditions receive the best care and sialorrhoea is well managed, we suggest a potential clinical care pathway for sialorrhoea with a MDT approach, which healthcare professionals could aspire to.

Authors+Show Affiliations

Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom; Department of Experimental and Clinical Medicine, University of Messina.Department of Rehabilitation Medicine, The Walton Centre NHS Foundation Trust, Liverpool, UK.Department of Rehabilitation Medicine, Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.Department of Medicine and Gerontology, University Hospital of Wales, Cardiff, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31819763

Citation

Morgante, Francesca, et al. "The Burden of Sialorrhoea in Chronic Neurological Conditions: Current Treatment Options and the Role of incobotulinumtoxinA (Xeomin®)." Therapeutic Advances in Neurological Disorders, vol. 12, 2019, p. 1756286419888601.
Morgante F, Bavikatte G, Anwar F, et al. The burden of sialorrhoea in chronic neurological conditions: current treatment options and the role of incobotulinumtoxinA (Xeomin®). Ther Adv Neurol Disord. 2019;12:1756286419888601.
Morgante, F., Bavikatte, G., Anwar, F., & Mohamed, B. (2019). The burden of sialorrhoea in chronic neurological conditions: current treatment options and the role of incobotulinumtoxinA (Xeomin®). Therapeutic Advances in Neurological Disorders, 12, 1756286419888601. https://doi.org/10.1177/1756286419888601
Morgante F, et al. The Burden of Sialorrhoea in Chronic Neurological Conditions: Current Treatment Options and the Role of incobotulinumtoxinA (Xeomin®). Ther Adv Neurol Disord. 2019;12:1756286419888601. PubMed PMID: 31819763.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The burden of sialorrhoea in chronic neurological conditions: current treatment options and the role of incobotulinumtoxinA (Xeomin®). AU - Morgante,Francesca, AU - Bavikatte,Ganesh, AU - Anwar,Fahim, AU - Mohamed,Biju, Y1 - 2019/11/28/ PY - 2019/06/20/received PY - 2019/10/08/accepted PY - 2019/12/11/entrez PY - 2019/12/11/pubmed PY - 2019/12/11/medline KW - Motor KW - Parkinson’s disease KW - botulinum toxin KW - incobotulinumtoxinA KW - neuron disease KW - sialorrhoea SP - 1756286419888601 EP - 1756286419888601 JF - Therapeutic advances in neurological disorders JO - Ther Adv Neurol Disord VL - 12 N2 - Sialorrhoea is a frequent symptom of neurological diseases (e.g. Parkinson's disease, motor neuron disease, cerebral palsy, and stroke) and is defined as excessive saliva accumulation leading to unintentional loss of saliva from the mouth. Sialorrhoea increases the overall burden on the patient and their caregivers, the impact of which can be both physical and psychosocial. Treatments for sialorrhoea range from lifestyle and behavioural guidance, to medications, surgery or radiation. Nonpharmacological interventions include advice on posture, swallowing control, cough management, dietary changes, eating and drinking techniques, and behavioural modification; however, these conservative measures may be ineffective for people with progressive neurological conditions. The pharmacological treatment of sialorrhoea is challenging because medications licensed for this purpose are limited, but treatments can include anticholinergic drugs and botulinum toxins. Surgical treatment of sialorrhoea is typically reserved as a last resort for patients. IncobotulinumtoxinA (Xeomin®) is the first botulinum toxin type A to receive US and UK marketing authorization for the symptomatic treatment of chronic sialorrhoea due to neurological disorders in adults. In this review, we discuss and compare the frequency and method of administration, location of treatment delivery, approximate annual costs and main side effects of botulinum toxin and different anticholinergic drugs. Management of patients with chronic neurological conditions requires input from multiple specialist teams and thus a multidisciplinary team (MDT) approach is considered fundamental to ensure that care is consistent and tailored to patients' needs. To ensure that adult patients with neurological conditions receive the best care and sialorrhoea is well managed, we suggest a potential clinical care pathway for sialorrhoea with a MDT approach, which healthcare professionals could aspire to. SN - 1756-2856 UR - https://www.unboundmedicine.com/medline/citation/31819763/The_burden_of_sialorrhoea_in_chronic_neurological_conditions:_current_treatment_options_and_the_role_of_incobotulinumtoxinA_(Xeomin®) L2 - http://journals.sagepub.com/doi/full/10.1177/1756286419888601?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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