Conditions Treated Using Botulinum Toxin In Parkinsons Disease
Diagnosing And Treating Sleep Apnea
Disruption To Saliva Flow In Pd
Impaired flow or consistency of saliva exposes to risks of lowered resistance to infection, depressed oral health, impaired bolus formation and transportation and implications for digestion. Consequences include dry mouth, ulceration, tooth decay, gingivitis, candidiasis, halitosis and perioral dermatological issues.12,19,22 Actual and perceived xerostomia or excess saliva in the mouth can influence voice quality and intelligibility beyond problems that stem from the underlying PD. Hyposalivation linked to medication or dysautonomia,12,20 or loss of saliva through drooling can affect bolus formation and exacerbate an already compromised swallowing mechanism. As the secondary effects from drooling are socially undesirable in many societies, presence of sialorrhea may bring repercussions for psycho-social health of the person who drools and added burden for the carer .
Prevalence figures suggest ca 1070% of people with PD are affected by drooling,2332 with no significant variation across ethnic groups.33 In investigations that report control data, drooling occurred in ca 615% of people unaffected by PD.25,28,30,34 Divergences in estimations reflect composition of populations studied, assessment methods and condition , patient vs clinician evaluation, as well as examination time .35
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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.
Managing Eating And Swallowing
It is important to continue eating normally as long as it is safe to do so. This will help to keep your muscles working, and maintaining a healthy diet is vital to good health . Only when eating and swallowing become significantly uncomfortable or difficult should you adapt your diet, for example by eating pureed foods.
Swallowing difficulties are individual and solutions vary from person to person, but the following tips on diet, drinking and eating techniques may help.
Is Drooling A Symptom Of Parkinsons Disease
Excessive drooling, called sialorrhea, is a common symptom of Parkinsons and can cause awkwardness in social situations. It ranges from mild wetting of the pillow during sleep to embarrassing outpourings of saliva during unguarded moments.
Ways To Deal With Drooling From A Neurologic Disorder
Some medical conditions may cause excess saliva. Several newer drooling treatment options can help, including therapy, medication, injections, and surgery.
When 61-year-old Deborah Clark first experienced trouble swallowing, she didn’t think much of it. But six months later, when she began having symptoms like slurred speech and difficulty projecting her voice, she visited a neurologist. Diagnosed with in February 2008, Clark quickly discovered how integral the muscles in her mouth were to her quality of life. Not only did she have difficulty speaking, but she also experienced excess saliva pooling in her mouth. At its worst, Clark found herself changing clothes up to four times a day because she had drooled down the front of her shirt.
“I was reluctant to be in public or around strangersespecially when a meal was involved,” says Clark. “People were always offering me tissues to control the drooling. It was embarrassing.”
Drooling, or sialorrhea, can be a major problem for people with neurologic conditions ranging from and to certain types of and ALS. People with these conditions may not have the brain control to coordinate muscle movements in the face and mouth.
If the anticholinergics stop workingor the side effects are intolerablesome physicians prescribe amitriptyline, an anti-depressant that dries up saliva. A bonus: amitriptyline improves sleep, which is often disrupted in patients with ALS, , and other neurologic disorders.
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Assessment Of Saliva Flow
Evaluation of saliva flow is challenged by a range of issues, including: difficulty obtaining objective measures in naturalistic settings time and place variability that exists in respect of natural variation in flow rates fluctuations in motor function experienced by pwPD that can impact on swallowing and saliva control the variety of situations across pwPD concerning where they experience difficulties or not and the subjective nature of whether an individual perceives there to be a problem present or not. Similar to other activity limitations in PD such as dysphagia and dysarthria, perceived magnitude of psychosocial impact of drooling, dry mouth and excess saliva does not necessarily correlate significantly with objective measures of saliva flow and loss.3,19,6567
These factors underline that no single assessment captures all dimensions important for establishing baseline and outcome measures of salivation/drooling. Accordingly, outcome evaluation covers a range of measurements, with a focus on key variables that encompass the patients own chosen concerns and goals.
How Is Drooling Treated
Drooling isnt always treated. Doctors usually wont recommend any treatment for someone under the age of 4 or who drools during sleep.
Treatment may be recommended when drooling is severe. Drooling may be considered severe if saliva drips from your lip to your clothing or your drooling interferes with your daily activities and creates social problems.
Excessive drooling can also lead to inhaling saliva into the lungs, which can cause pneumonia.
Treatment options are looked at on a case-by-case basis, but generally your doctor will perform an assessment and come up with the management plan that works best for you.
The noninvasive approach includes trying things such as medication and oral motor therapy. In more serious cases, you and your doctor may consider a more invasive approach, including treatment options such as surgery and radiotherapy.
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Management Of Saliva Flow
The British NICE guidelines for PD2 recommend referral to a speech-language clinician for assessment and treatment of drooling, though overall management is multidisciplinary. The guidelines advocate behavioral methods of intervention in the first instance, followed by consideration of pharmacological or surgical options if/when these are ineffective.
Swallowing Difficulties And Parkinsons Medication
If swallowing tablets or capsules becomes difficult, it may be tempting to crush tablets or open capsules, but this should never be done, as it can cause serious side effects and/or prevent the medication working properly. Always ask your pharmacist or doctor, or check the patient information leaflet before tampering with medicines in any way. Swallowing medications with jelly, yoghurt or apple sauce may help you swallow medication more comfortably.
Many Parkinsons medicines are prepared or designed to work in a particular way that will be harmed by crushing or opening capsules. For example, some medicines have:
- Sugar or film coating: This is usually to make them taste better, but crushing may make them taste unpleasant.
- Enteric coating: This coating is designed to keep the tablet whole in the stomach, in some cases to protect the stomach or to protect the medicine from stomach acid so that it is released after passing through the stomach, for example in the intestine. This type of tablet should never be crushed.
- Modified or controlled release: These medications have been designed to release slowly and act over a longer period, so they can be taken less often. Crushing this type of tablet would lead to a rapid release of the medicine which could be harmful.
If you experience any problems you should talk to your doctor, so that he or she can prescribe medication in a form that is easier to take. Some medicines are available in liquid form.
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Talk To Your Doctor About Other Options
Medications that affect the salivary glands could help adults who struggle with drooling. The most commonly prescribed medication for this is Scopolamine, which is also known as Hyoscine. This drug is primarily used to reduce motion sickness, vomiting and is sometimes given before surgery to reduce saliva production.
If the tongue and jaw muscles arent experiencing a full range of motion, your doctor may recommend speech therapy. This course of treatment is also recommended for patients whose lips dont connect when they close their mouths. This solution isnt an overnight cure, but it could help a patient improve over time.
Botox is the Botulinum toxin that is commonly known as a facial injection to smooth out wrinkles. The muscles under the skin that contract create wrinkles as we age, and botox paralyzes these. The same principle applies to the salivary glands, so by injecting Botox into the glands, they will cease to function and stop creating saliva.
The last resort is to explore surgery, which is only recommended when theres an incurable neurological condition responsible for the drool. The most common method is to remove the salivary glands, and recovery can vary from a few weeks to a few months.
What Is A Swallowing Evaluation
If because of the above signs there is concern that swallowing difficulties exist, your doctor may recommend a swallow evaluation, which can be performed by a speech and language pathologist.
There are two main ways to evaluate someones swallow:
- Modified barium swallow study This is the most common test that is performed. The person is asked to ingest different consistencies of barium and moving x-rays are taken that follow the barium as it is swallowed. This x-ray video pinpoints the areas of the swallow that are problematic and helps to determine the correct exercises to address the problem.
- Fiberoptic endoscopic evaluation of swallowing is another type of test that can be performed to evaluate swallow. During this procedure, a very thin flexible fiberoptic tube which is hooked up to a camera and light source, is passed through the nasal passage. The tube does not go down the throat, but allows swallowing to be observed. This procedure is painless and well-tolerated by most individuals.
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Is Drooling Normal In Adults And The Elderly
While it may be common in elderly citizens, its not considered normal, and theres typically an explanation for the drooling. Drooling is often due to either a neurological disorder or a side effect of a medication. For example, a senior adult who is taking drugs for dementia or Parkinsons could produce excessive drool as a result of the medication.
Often in the case of elderly patients, the drooling occurs during the day as well, whether its due to a neurological condition or a side effect of their prescriptions. Because this can be extremely embarrassing as well as a potential health hazard, drooling as an adult should be addressed immediately.
Measurement Of Related Variables
In as far as ptyalism in PD may be linked to other symptoms, other assessments may be pertinent to place real and perceived drooling in its broader context. These cover assessment of swallowing, speech and voice.3,65 Detailed dental examination and monitoring of oral health may be indicated for some individuals, over and above routine dental supervision.22,83
People with PD may experience dry mouth/xerostomia.21 Perceived dryness does not necessarily reflect objective levels of dryness defined by salivary flow rate/volume, mucosal wetness and saliva consistency.84 The Clinical Oral Dryness Score 85 is a validated clinician-administered semi-quantitative tool. The score comes from observing the presence/absence of ten symptoms and signs characteristic of dry mouth. It is combined with a 010 rating by the patient on how far they are bothered by xerostomia. Perceived impact has also been gauged using five questions related to possible activity and participation restrictions commonly reported by people with xerostomia.85
The PDQ3944 contains items on avoiding eating and drinking in public and speech/communication problems, but has nothing specific to drooling, despite several studies employing it as a sialorrhea rehabilitation outcome measure.
Assessment Tools For Drooling In Pd
The assessment tools to evaluate drooling in PD include both objective and subjective measures. Objective tools were developed to measure the volume of saliva and salivary flow. The limitations of these tools are that they are time-consuming and cannot evaluate the psychosocial impairment. Therefore, subjective tools were developed. The subjective measures in many previous studies were the UPDRS part II salivary subscores to evaluate drooling treatment responses and visual analog scales to assess the frequency, familial and social distress however, not all scales are validated. Three drooling-specific rating scales including the Drooling Severity and Frequency Scale , Drooling Rating Scale and Sialorrhea Clinical Scale for PD have been used to evaluate drooling in PD. The DSFS, a semi-quantitative scale, was used in studies to evaluate drooling in PD and cerebral palsy . The scale is composed of two domains: the severity of drooling rated on a five-point scale and frequency of drooling rated on a four-point scale. Since the DSFS is easy to administer it is widely used. However, the limitations of this scale are no assessment of the psychosocial impact, no validation and no evidence of correlation between this scale and the objective measures of salivary secretion.
Does Benadryl Help With Excessive Saliva
The antihistamine diphenhydramine can also reduce hypersalivation, with no increases in rates of constipation when compared to placebo. The antihistamine chlorpheniramine and benzamide derivatives both reduce hypersalivation, but adverse effects were not reported.
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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.