Should I Talk To My Healthcare Provider Before I Start Exercising If I Have Parksinson’s Disease
Talk to your neurologist and your primary care provider before starting a new exercise regimen. They can:
- Counsel you on how intense your exercises can be.
- Recommend exercises appropriate for your individual health.
- Refer you to a physical therapist to create a personal exercise program.
- Warn about exercises to avoid based on your particular challenges or limitations.
Efficacy Of Botulinum Toxin For Treating Sialorrhea In Neuromuscular Conditions
- 1Department of Neurology, University of Missouri, Columbia, MO, United States
- 2Assistant Professor of Neurology, Department of Neurology, University of Missouri, Columbia, MO, United States
Background: Drooling related to bulbar weakness and dysfunction is a common concern in patients with neuromuscular disease. While there are numerous medications to manage sialorrhea, they are often limited by side effects and lack of efficacy. Botulinum toxin has shown to benefit ALS patients in a few studies, but there is scant data on the benefit in other neuromuscular conditions.
Objective: To assess the effectiveness of Botulinum toxin in reducing sialorrhea in patients with various neuromuscular disease.
Design/Methods: 25 patients with documented neuromuscular illness and concern for drooling was followed for 6 weeks after Botulinum toxin injection. These patients had one of the following diagnoses: Duchenne muscular dystrophy , myotonic dystrophy , oculopharyngeal muscular dystrophy , inclusion body myositis , primary lateral sclerosis , amyotrophic lateral sclerosis , spinal muscular atrophy type 2 and 3 , spinal-bulbar muscular atrophy , and Becker’s muscular dystrophy . A subjective drooling scale and drooling thickness score was calculated on these patients prior to the injection and 4 and 6 weeks after the injection. Botulinum toxin 2030 units were injected into bilateral parotid gland and submandibular gland .
How Do You Know If You Or Your Loved One Has A Problem With Swallowing
Swallowing difficulties can start very subtly and initially not be obvious to either the person with PD or their loved ones. There are signs to look out for before swallowing difficulty becomes overt . Some of the signs you should pay attention to include:
- Slow rate of eating people with difficulty swallowing may slow down their eating in order to avoid coughing or choking
- Fatigue during eating or decreased enjoyment of food
- A sensation that food is sticking in the throat
- Coughing or excessive throat clearing during eating
- Difficulty in swallowing pills
- Unexplained weight loss people with difficulty swallowing may reduce their consumption in an attempt to eat without coughing or choking
- Change in dietary habits people with difficult swallowing may alter their diet in order to avoid foods that cause difficulty. This may not be a choice made consciously
- Diagnosis of a pneumonia this could be caused by aspiration, or entry of a foreign substance into the airway
If you think there might be a swallowing issue, it is important to speak with your doctor about it. There are steps you can take to properly assess the situation and improve your swallowing function. This can in turn reduce your risk of choking, make eating more enjoyable, and lessen the chances of unwanted weight loss and/or other discomforts.
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Botox For Chronic Pain
Did you know that Botox is used for more than wrinkles?
Botox was actually first used in the 1980’s to help treat children with strabismus “crossed- eyes”. Neurological conditions such as cervical dystonia, blepharospasm, focal muscle spasticity , hemifacial spasm, are all Health Canada approved for Botox treatment. In the dermatology area, it is also approved for hyperhidrosis and cosmetics . Emerging research supports its use for chronic pain including migraine headaches, myofascial pain, neuropathic pain and even arthritis.
In the early 1990’s, a dermatologist noted that the patients treated by his ophthalmologist wife for blepharospasm had less wrinkles. This led to the whole “cosmetic industry” use of Botox. In the mid 90’s, an ENT specialist reported that patients getting Botox for wrinkles had less migraine headaches. This led to an explosion of research in the area of pain including myofascial pain, low back pain, fibromyalgia, arthritis and neuropathic pain .
Based on strong clinical evidence, the FDA approved Botox for chronic migraine headaches in November 2010. Health Canada has also approved as of October 19, 2011. A new German Botox known as Xeomin is also now available in Canada.
Is Botox the new “aspirin” of the decade?
What Is Botulinum Toxin
Botulinum toxin is a substance produced by the bacteria Clostridium botulinum. Botulism is caused by the harmful effects of this toxin. If the toxin enters the bloodstream, it can spread throughout the body, causing widespread muscle weakness. In its full-blown form, botulism can cause difficulty with swallowing and breathing by causing weakness of the muscles that control these functions.
The good news is that decades ago, scientists learned how to isolate the toxin and harness its power for medical use, and it can be safely injected into particular muscles in order to decrease unwanted movements of those muscles.
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Botox For Salivary Glands
Has anyone had botox injected into the salivary glands to assist with reducing excessive saliva? My husband is having a difficult time with excessive saliva and almost seems to be drowning at times. We are also planning on seeing a movement disorder clinic about the possibility of DBS, and had heard that that can also help with swallowing and excessive salivation as well.
So – I see the earlier post! Thanks all!
I don’t know about salivary glands specifically, but my GP used Botox injections into both sides of my jaw with great results. Details available if you want them.
Hi! My husband receives quarterly Botox for excess saliva. Speech therapy also helps – this strengths the muscles in your throat. Hope this helps!
My husband has tried lots of different meds all of them had dreadful side effects . Hallucinating ,
Since trying glycopperate it’s improved beyond belief .. Still has a little but the throat and chest much easier and helps with choking control episodes . It’s delivered but a dropper .
What is glycopperate? I googled it to no avail.
Try glycopperonium. . John has been I ver sensitive to lots of meds but so far no problem with this . I did start nervously a little at a time
So far so good . I am not getting through boxes and boxes of tissues OF jumping up and down continuously . He is managing to speak a little easier as well
We will investigate further! Thanks!
Botulinum Toxin In Sialorrhea
Botulinum toxin has class A evidence in the treatment of sialorrhea. Both botulinum toxin A and B have been used in the treatment of sialorrhea, and have been shown to have fewer side effects than comparative treatment . By injecting botulinum toxin locally into the salivary glands, the production of saliva is reduced, and the risks of systemic effects are limited. Botulinum toxin A was first used by Pal et al., who showed a marked improvement in the reduction of saliva and a 66% subjective improvement in patients . In 2004, a study by Ondo et al. showed similar efficacy of botulinum toxin B in the treatment of drooling . Further pivotal studies have led to botulinum toxins becoming FDA-approved therapies for the treatment of sialorrhea, particularly serotypes IncobotulinumtoxinA and RimabotulinumtoxinB .
The therapeutic uses of botulinum toxin A and B are well recognized and rapidly expanding. There are three botulinum A toxins: AbobotulinumtoxinA, IncobotulinumtoxinA, and OnabotulinumtoxinA, and one botulinum B toxin, RimabotulinumtoxinB. Each work in slightly different ways and have different indications. All four agents differ in complexity, purity, potency, dosing, and immunogenicity . Key differences between the four major botulinum toxins are listed in the Table 1 below.
Table 1. Comparing the four major botulinum toxins.
|No FDA approval for Sialorrhea||Allergan US|
|No FDA approval for Sialorrhea||Ipsen|
|2500 U and 3500 U||Dry mouth, dysphagia, and dental caries|
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Excessive Sweating And Body Odor
For those who sweat too much or who have trouble reducing their body odor with the use of traditional deodorants, Botox injections may be helpful, research has shown. Normally, sweat is produced when the small muscles around sweat glands squeeze the liquid out, Maman said.And if you can paralyze those small muscles, then the sweat glands are no longer functioning like they normally would, he said.
In a 2007 study published in the journal Dermatologic Surgery, researchers injected Botox into the armpits of 51 people. Both the participants and the independent raters of smell samples from the peoples armpits said the peoples underarm odor was less unpleasant after they received the injections. Botox was approved by the FDA to treat excessive sweating in 2004.
What Does Botulinum Toxin Treatment For Parkinsons Look Like
The effects of Botulinum toxin take hold about 3-10 days after the injections and last approximately three to four months, so the treatments typically need to be repeated on a regular basis. Although this means routine injections, it also means that Botulinum toxin injections do not have any permanent side effects. Some side effects may still occur with Botulinum toxin injections and the doctor who performs the procedure will review these with you. An advantage of using Botulinum toxin for the treatment of the conditions noted above, is that the toxin typically only impacts the areas into which it is injected, as opposed to oral medications which have a more widespread effect, and therefore more potential for side effects.
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Are There Potential Side Effects
Side effects from botulinum toxin injections are infrequent and transient. For blepharospasm patients, mild side effects may include drooping of the eyelid, blurred vision, facial asymmetry and double vision. Tearing may occur.
General side effets of botulinum toxin injections may include pain, tenderness and/or bruising at the injection site, difficulty swallowing, upper respiratory infection, neck pain and headache. Most side effects recover spontaneously.
Rare but serious side effects include severe problems swallowing, serious heart problems and severe allergic reactions. If you are experiencing a severe side effect, contact emergency services immediately.
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Conditions Treated Using Botulinum Toxin In Parkinsons Disease
Data Collection And Analysis
Selection of studies
We will merge search results using reference management software, remove duplicate records of the same report, and import the results into Covidence, a webbased systematic review software platform . In Covidence two review authors will independently examine titles, abstracts and key words identified from the literature search. The results of this search will be categorised as either yes, no, or maybe relevant. If it is unclear from titles and abstracts whether a study should be included, we will obtain full texts of these trial reports for further examination. We will resolve disagreement about selection of studies by consensus discussion. We will list those studies excluded in the Characteristics of excluded studies table. FH will retrieve full texts of relevant and potentially relevant reports and link multiple reports of the same study. Two authors will independently examine the full texts for compliance with eligibility criteria. We will contact study authors for further information, where appropriate, to clarify study eligibility. The review team will not be blinded to information about study authors, institutions, journal of publication, or results. We will resolve any disagreements through discussion.
Data extraction and management
Assessment of risk of bias in included studies
Measures of treatment effect
0% to 40%: might not be important.
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Genetic And Environmental Interactions
Although several genetic mutations have been identified to be associated with a higher risk of developing Parkinson’s disease most people do not have these genetic variations.
On the other hand, even though pesticides and head traumas are associated with PD, most people do not have any obvious exposure to these environmental factors.
Parkinson’s is caused by a combination of genes, environmental and lifestyle influences. The interaction of all three components determines if someone will develop Parkinson’s. Parkinsons-specific research is critical to better understanding how these components interact to cause PD and how to prevent it.
Page reviewed by Dr. Lauren Fanty, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.
Oral Dysfunction In Parkinsons: Swallowing Problems And Drooling
Two common and distressing problems that can develop in Parkinsons disease are swallowing dysfunction and drooling. I want to help you better understand these issues and learn what you can do to improve them so read on!
Thank you to Christine Sapienza, PhD, CCC-SLP and Bari Hoffman Ruddy, PhD, CCC-SLP for providing some of the material below.
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Swallowing Exercises Can Be Very Helpful To Improve Your Swallowing
After a formal swallow assessment, swallowing therapy sessions can be designed for you, involving exercises tailored to the specific parts of your mouth and throat that are causing the swallowing problem. Sessions may involve practicing compensatory swallowing strategies with various types of foods in order to maximize safety and efficiency while swallowing.
During swallow therapy, recommendations may include:
- Best feeding techniques
- Exercises to strengthen oral and throat muscles
- Compensatory techniques to assist in safe swallowing
- Oral and mouth care techniques
- Appropriate food selection and ways to modify food texture
- Safe positioning strategies
- Patient/family education
Why Does Parkinsons Disease Cause Drooling
Saliva is produced by small glands around our mouth, called Salivary glands.
It is a common misconception that Parkinsons patients have drooling because they are producing too much saliva. In fact, multiple studies have shown that most Parkinsons patients produce less saliva.
Our salivary glands continuously produce saliva, even when we are not eating.
Normally, we automatically swallow this saliva, through small gulps that we dont even notice.
But in Parkinsons disease, there is a marked decrease in all automatic movements, including automatic swallowing.
Therefore, saliva accumulates in the mouth. When the mouth is full, it drips out. We call this Drooling.
Lets talk about treatment
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Side Effects Of Using Botox
In general, side effects of Botulinum toxin can be due to over-weakening of the injected muscle, which, if done on leg and foot muscles, for example, could interfere with walking.
Uncommonly, Botulinum toxin can diffuse to neighboring muscles and cause more widespread side effects. For example, injections of neck muscles could result in toxin diffusing locally to muscles used for swallowing and cause difficulty swallowing. Even less common, are side effects due to travel of the toxin to more distant parts of the body via the bloodstream. For example, injections of any body part could theoretically result in difficulty swallowing or breathing if the toxin travels to these muscles. This is very rare however and Botulinum toxin injections are typically very safe. The full risk profile for your particular situation however, needs to be discussed with the physician performing the injections.
There are typically no limitations after the injections and you can return immediately to your normal activities.
Although dermatologists often use Botulinum toxin for cosmetic purposes, only a neurologist is qualified to determine whether the injections can help with certain PD symptoms. If you are interested to investigate whether Botulinum toxin injections may help you, discuss this with your neurologist. If he/she feels that they may be helpful, but does not perform them, he/she can refer you to a neurologist who does.
Tips and takeaways
Where Can I Find Support If I Have Parkinson’s Disease And Want To Exercise
You can find exercise support in your community. For example, many gyms and community centers offer seated exercise classes for people who struggle with balance. Ask your healthcare provider for ideas if you have Parkinsons disease and want to exercise.
A note from Cleveland Clinic
Exercise is an important part of managing Parkinsons disease. Talk to your healthcare provider about your exercise program and choose activities you enjoy so you stay motivated to get up and move every day.
- Michael J. Fox Foundation for Parkinsons Research. Exercise. Accessed 4/13/2021.
- Parkinson Society of Canada. Exercises for People with Parkinsons. Accessed 4/13/2021.
- Parkinsons Foundation. Exercise. Accessed 4/13/2021.
- Journal of Parkinsons Disease. The Universal Prescription for Parkinsons Disease: Exercise. Accessed 4/13/2021.
- Centers for Disease Control and Prevention. Perceived Exertion . Accessed 4/13/2021.
- Neurotherapeutics. Current Perspectives on Aerobic Exercise in People with Parkinsons Disease. Accessed 4/13/2021.
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