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Sialorrhea in patients with ALS: current treatment options

Authors Garuti G, Rao F, Ribuffo V, Sansone VA

Received 23 October 2018

Accepted for publication 28 February 2019

Published 20 March 2019 Volume 2019:9 Pages 19—26

DOI https://doi.org/10.2147/DNND.S168353

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 4

Editor who approved publication: Prof. Dr. Thomas Müller


Giancarlo Garuti,1 Fabrizio Rao,2 Viviana Ribuffo,1 Valeria A Sansone3

1Pneumology Unit, Santa Maria Bianca Hospital, Mirandola, ASL Modena, Modena, Italy; 2Respiratory Unit, Neuromuscular OmniCentre (NeMO), Neurorehabilitation, University of Milan, Niguarda Hospital, Milan, Italy; 3Neuromuscular Omnicentre (NeMO), Neurorehabilitation, University of Milan, Niguarda Hospital, Milan, Italy

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.

Keywords: amyotrophic lateral sclerosis, sialorrhea, botulinum toxin, radiotherapy salivary gland, anticholinergic drug

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