Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030567 (Parkinson's disease)
 63,064 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Aim: To assess quantitatively sialorrhea in Parkinson's disease (PD) and the efficacy of botulinum toxin (BOTOX) in its treatment.Material: 11 patients with a clinical diagnosis of idiopathic PD and drooling were assessed at least two points on the UPDRS Part II and 14 control subjects.Methods: Salivation was measured by weighing dental rolls before, and 2min after, insertion at six points of highest secretion of saliva in the mouth (buccal vestibule, and sublingual area). PD patients were assessed before and 1 week after injections of five units of BOTOX into each parotid salivary gland and the results were compared to the salivation production of controls.Results: Average secretion of saliva in PD patients was significantly higher than in controls-0.39+/-0.4g/2min. (range: 0.02-1.82) vs 0.19+/-0.16g/2min. (range: 0.02-0.98) (P=0.03). After treatment, the average secretion of saliva in PD patients decreased to 0.25+/-0.26g/2min. (range: 0.004-0.99) and did not differ significantly from controls. Nine patients improved also according to UPDRS. No side effects were observed in any of the patients injected.Conclusion: Botulinum toxin may be an effective and safe treatment of parkinsonian sialorrhea.
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PMID:Quantitative assessment of parkinsonian sialorrhea and results of treatment with botulinum toxin. 1134 19

The aim of the present study was to assess the efficacy and safety of chronic subthalamic nucleus deep-brain stimulation (STN-DBS) in patients with Parkinson's disease (PD). 18 consecutive severely affected PD patients were included (mean age, SD: 56.9+/-6 years; mean disease duration: 13.5+/-4.4 years). All the patients were evaluated clinically before and 6 months after the surgical procedure using the Unified Parkinson's Disease Rating Scale (UPDRS). Additionally, a 12 months follow-up was available in 14 patients. The target coordinates were determined by ventriculography under stereotactic conditions, followed by electrophysiology and intraoperative stimulation. After surgery, continuous monopolar stimulation was applied bilaterally in 17 patients at 2.9+/-0.4 V through 1 (n = 31) or 2 contacts (n = 3). One patient had bilateral bipolar stimulation. The mean frequency of stimulation was 140+/-16 Hz and pulse width 68+/-13 micros. Off medication, the UPDRS part III score (max = 108) was reduced by 55 % during on stimulation (score before surgery: 44.9+/-13.4 vs at 6 months: 20.2+/-10; p < 0.001). In the on medication state, no difference was noted between the preoperative and the postoperative off stimulation conditions (scores were respectively: 17.9+/-9.2 and 23+/-12.6). The severity of motor fluctuations and dyskinesias assessed by UPDRS IV was reduced by 76 % at 6 months (scores were respectively: 10.3+/-3 and 2.5+/-3; p < 0.001). Off medication, the UPDRS II or ADL score was reduced by 52.8 % during on stimulation (26.9+/-6.5 preop versus 12.7+/-7 at 6 months). The daily dose of antiparkinsonian treatment was diminished by 65.5 % (levodopa equivalent dose -- mg/D -- was 1045 +/- 435 before surgery and 360 +/- 377 at 6 months; p < 0.01). These results remained stable at 12 months for the 14 patients studied. Side effects comprised lower limb phlebitis (n = 2), pulmonary embolism (n = 1), depression (n = 6), dysarthria and freezing (n = 1), sialorrhea and drooling (n = 1), postural imbalance (n = 1), transient paresthesias and dyskinesias. This study confirms the great value of subthalamic nucleus stimulation in the treatment of intractable PD. Some adverse events such as depression may be taken into account in the inclusion criteria and also in the post-operative outcome.
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PMID:Subthalamic nucleus stimulation in Parkinson's disease: clinical evaluation of 18 patients. 1202 40

Sialorrhea is a relatively common symptom in idiopathic Parkinson's disease and related conditions for which most of the accepted treatments are either highly invasive or may cause substantial systemic side effects. This study describes an open-label pilot study of sublingual atropine drops for the treatment of sialorrhea in 7 patients (6 with Parkinson's disease, 1 with progressive supranuclear palsy). Participants demonstrated statistically significant declines in saliva production, both objectively and subjectively. Self-reported drooling severity showed a significant decline between baseline and 180 minutes, t(6) = 3.240 P < 0.025 (eta(2) = 0.636), and between baseline and 1 week, t(6) = 4.583 P < 0.005 (eta(2) = 0.778). Objectively measured saliva production decreased significantly between baseline and the 1-week follow-up, t(6) = 2.711 P < 0.05 (eta(2) = 0.551). Delirium occurred in 1 patient (concurrent with a urinary tract infection), and 2 patients experienced worsening of hallucinations (active hallucinosis was concealed by both individuals to allow participation in the trial). The remaining trial participants did not experience any anticholinergic side effects. This trial shows that, in selected patient populations, sublingual atropine is a simple and inexpensive treatment for sialorrhea associated with parkinsonism.
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PMID:Sublingual atropine for sialorrhea secondary to parkinsonism: a pilot study. 1246 75

Drooling is a frequent symptom in Parkinson's disease (PD), occurring in almost 75% of all patients. Although it is now well known that drooling in PD is the result of swallowing difficulties rather than excessive saliva production, few treatments have been developed to reduce it. Clinical studies suggest that botulinum toxin A (BTX) injections into salivary glands are effective in decreasing drooling in PD patients. In this double-blind, placebo-controlled study, 20 patients with parkinsonism (idiopathic PD or multiple system atrophy), were randomly assigned to receive 450 U of BTX (Dysport; Ipsen, Berkshire, UK) or 2 ml of placebo, injected into the parotids and submandibular glands under ultrasonographic guidance. Treatment efficacy and safety were assessed at baseline, 1 week and 3 months after BTX injections using clinical scales (Drooling Severity and Drooling Frequency scales) and side effects surveillance. After treatment, the average secretion of saliva in the BTX group was significantly lower than in the placebo group, as appraised by clinical measurements. No side effects were observed in either group. BTX injection into parotids and submandibular glands, under ultrasonographic guidance, is an effective and safe treatment for drooling in parkinsonism.
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PMID:Double-blind, placebo-controlled study to evaluate the efficacy and safety of botulinum toxin type A in the treatment of drooling in parkinsonism. 1278 73

Sialorrhea (drooling or excessive salivation) is a common problem in neurologically impaired children (i.e., those with mental retardation or cerebral palsy) and in adults who have Parkinson's disease or have had a stroke. It is most commonly caused by poor oral and facial muscle control. Contributing factors may include hypersecretion of saliva, dental malocclusion, postural problems, and an inability to recognize salivary spill. Sialorrhea causes a range of physical and psychosocial complications, including perioral chapping, dehydration, odor, and social stigmatization, that can be devastating for patients and their families. Treatment of sialorrhea is best managed by a clinical team that includes primary health care providers, speech pathologists, occupational therapists, dentists, orthodontists, neurologists, and otolaryngologists. Treatment options range from conservative (i.e., observation, postural changes, biofeedback) to more aggressive measures such as medication, radiation, and surgical therapy. Anticholinergic medications, such as glycopyrrolate and scopolamine, are effective in reducing drooling, but their use may be limited by side effects. The injection of botulinum toxin type A into the parotid and submandibular glands is safe and effective in controlling drooling, but the effects fade in several months, and repeat injections are necessary. Surgical intervention, including salivary gland excision, salivary duct ligation, and duct rerouting, provides the most effective and permanent treatment of significant sialorrhea and can greatly improve the quality of life of patients and their families or caregivers.
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PMID:Sialorrhea: a management challenge. 1520 98

Hypersialorrhea is a common phenomenon in Parkinson disease (PD). The objective of this study was to determine whether patients with PD had an abnormally increased production of saliva and whether the production of saliva could be associated to factors related to either the disease characteristics or to its treatment. A total of 83 patients with PD and 55 control subjects participated in this study. Because of the age difference between the two groups, comparisons were made on a +/-2-year age-matched sample of 44 PD patients and 44 control subjects. PD patients produced significantly less saliva than control subjects. Correlations were obtained with the 83 PD patients between unstimulated salivary flow and patients characteristics. When controlling for age, sex, and Hoehn and Yahr scale, decreased production of saliva correlated significantly with the dose of levodopa and the symptoms of xerostomia. When controlling for medications, there was no relationship between the production of saliva and the evolution of the disease. This study shows that patients with PD produce less saliva than normal. Factors influencing the production of saliva include the use of levodopa and female gender. Our results may have implications for the treatment of drooling in PD.
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PMID:Salivary production in Parkinson's disease. 1538 96

Hypersalivation (sialorrhea) is a common complaint of patients with neurodegenerative disorders such as Parkinson's disease or amyotrophic lateral sclerosis and a frequently disabling side effect of atypical antipsychotic drugs. Conventional treatment including oral anticholinergic or antihistamine medication is often limited by adverse effects and lack of efficacy. Over the past few years, several studies reported decreased drooling after injections of botulinum toxin into the salivary glands. This review describes the current state of treatment of sialorrhea with botulinum toxin.
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PMID:[Treatment of sialorrhea with botulinum toxin: an overview]. 1646 34

Besides the core motor features of Parkinson's disease, other disorders such as gastro-intestinal dysfunction, postural hypotension, urinary, genital, sleep problems and pain contribute to the alteration of patient's quality of life. Drooling, swallowing difficulties and constipation are the more frequent digestive problems. Aspirations may be life-threatening. Sexual dysfunction as well as iatrogenic hypersexuality may be deleterious for the couple well-being. Symptomatic postural hypotension is the main manifestation of autonomic failure and needs a specific management. Pain is frequent in Parkinson's disease, particularly due to frozen shoulder or to the peculiar picture of "primary sensory pain symptoms". Sleep disorders are common in Parkinson's disease and are associated with reduced quality of life and increased risk of vehicle accident particularly when excessive daytime somnolence occurs.
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PMID:[Parkinson's disease and associated disorders]. 1596 17

Sialorrhoea (drooling or excessive salivation) is a common symptom of many neurological diseases (e.g., amyotropic lateral sclerosis, cerebral palsy and Parkinson's disease) and otolaryngologic diseases (tumours of upper aerodigestive tract). It is mostly caused by poor oral and facial muscle control in patients with swallowing dysfunction (secondary sialorrhoea). However, some cases of sialorrhoea are due to hypersecretion of saliva. These cases represent so-called primary sialorrhoea.
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PMID:Controlling sialorrhoea: a review of available treatment options. 1608 42

To investigate the safety and efficacy of botulinum toxin type A (BoNTX) treatment to reduce sialorrhea in Parkinson's disease (PD), a double-blind, randomized, placebo-controlled study enrolled 32 PD patients complaining of excessive drooling. Patients received either 50 U Botox in each parotid gland or placebo without using ultrasound guidance. Subjects treated with BoNTX experienced a reduction in both drooling frequency and familial and social disability (TimexGroup effect: P<0.01), as well as in saliva production (Time x Group effect: P<0.0001). No adverse events were recorded. BoNTX injections are safe and effective treatment for the management of PD-related drooling.
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PMID:Botulinum toxin type A for drooling in Parkinson's disease: a double-blind, randomized, placebo-controlled study. 1644 Mar 32


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