Swallowing Difficulties In Parkinsons Disease
The act of swallowing involves a complex series of activities that begin in the mouth, continue in the pharynx and end in the esophagus. These include chewing, using the tongue to move the bolus of food to the back of the throat and then coordinating the muscles that both propel the food into the esophagus and protect the airway or trachea from food penetration. Swallowing dysfunction can be considered both a motor and a non-motor symptom of PD. Loss of dopamine neurons in the substantia nigra area of the brain can cause the motor dysfunction that impairs swallowing. However, loss of neurons in other areas of the brain, such as the cortex and lower brain stem can also affect the overall control and coordination of swallowing, and can be thought of as a non-motor symptom of PD. Swallowing issues are very important to diagnose. Impacts on your daily life and your health can range from difficulties with meals to more extreme cases where it could lead to choking and aspiration which can be very serious or even fatal.
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.
Awareness Of Nonmotor Symptoms Of Parkinsons Disease Is Growing During The Last Decade
How to stop drooling in parkinsons. Hallucinations and delusions are potential complications of parkinsons disease . Keep your chin up and your lips closed when you arent speaking or eating. In these matters, it is best to consult your physician immediately.
Also, crushed ice partially melted tastes really good. Consult with your movement disorder doctor about your concerns, challenges, and discuss treatment options, and possible medication adjustment. Drooling, also known as ptyalism or sialorrhea can be defined as salivary incontinence or the involuntary spillage of saliva over the lower lip.
If a person is drooling while asleep, switching to sleeping on the back may be a quick fix. Sialorrhea can affect up to 3 out of 4 patients with parkinsons disease. Some of these disorders include increased prevalence of caries and periodontal disease, sialorrhea and drooling, xerostomia, orofacial pain, bruxism, and taste impairment.
If you drink all of the time you are able to swallow all of the time A new survey, created by the european parkinsons disease association in partnership with pharmaceutical company merz, aims to understand how drooling affects people with parkinsons, and how it is approached by healthcare professionals. In older children, the reason may be a developmental disorder.
Adult drooling may be due to an overproduction of saliva. Do all of your grooming (shaving, drying your hair, etc. Keep it by their bed at night too.
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Is Drooling During Sleep Normal
In many cases, drooling during sleep is normal. Saliva production varies over the course of a day, perhaps according to a circadian rhythm. Although people generally produce more saliva during the day and less at night, saliva production continues during sleep. This saliva performs the important task of keeping your mouth and throat lubricated, which is required for good health. Continued saliva production during sleep makes drooling possible.
Although drooling while asleep is often normal, it might lead to unwanted consequences. For example, excessive drooling can cause chapping around the lips and mouth, bad breath, dehydration, and feelings of embarrassment.
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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.
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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.
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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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Different Types Of Botulinum Toxin
There are eight different botulinum toxin species that occur in nature. There are only two however, that are produced commercially Botulinum toxin A and B.
The commercially available products are:
Each of the above agents are FDA approved for a slightly different list of clinical indications.
What Is The Outlook For Persons With Parkinsons Disease
Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.
Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.
The future is hopeful. Some of the research underway includes:
- Using stem cells to produce new neurons, which would produce dopamine.
- Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
- Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.
Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.
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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
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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Survey On Drooling In Parkinson’s
In October and November 2020, the EPDA carried out a survey focused on drooling a very important yet often-overlooked Parkinsons symptom.
The results demonstrate how much of an impact sialorrhea can have on people with Parkinsons not just on swallowing itself but also on quality of life and communication. They also show that a large percentage of people have not discussed this important symptom with their healthcare professionals and have therefore not received suitable advice about the possible treatment options available.
Learn more about this project and including all the survey findings, as well as important recommendations and advice on how to manage your sialorrhea if you have Parkinsons.
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
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Excessive Saliva And Drooling In Parkinsons
Saliva is needed for the first stages of digestion, including chewing and swallowing. This watery substance contains enzymes that start to digest our food.
Many people with Parkinsons experience poor saliva control, which may result in excessive saliva and drooling, or alternatively, in a dry mouth and other eating problems.
Inflammation Of The Epiglottis
Epiglottitis is inflammation of the epiglottis, tissue that covers the trachea , which helps prevent coughing or choking after swallowing. It is usually caused by the bacteria H. Influenzae but can also be caused by other bacteria or viruses that cause upper respiratory infections.
Top Symptoms: being severely ill, shortness of breath, fever, sore throat, pain with swallowing
Symptoms that never occur with inflammation of the epiglottis: cough
Urgency: Emergency medical service
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How Does Botox Work
Usually, a message gets transmitted from the nerve to the muscle by release of the chemical acetylcholine from the nerve endings. When Botulinum toxin is injected into a muscle, it gets taken up by the nerve endings that interface with the muscle, and interferes with the release of acetylcholine, thereby stopping communication between the nerve and the muscle. When this communication is decreased, the muscle is weakened and certain Parkinsons symptoms are lessened.
Normal Physiology Of Salivation And Swallowing
The processes of salivation are controlled by both sympathetic and parasympathetic nervous system. However, facilitation of ingestion and swallowing are mainly contributed by parasympathetic nervous system. The parasympathetic afferent pathways receive unconditioned reflex stimulation from the pharynx and esophagus. Then, signals are conducted via the vagus and spinal splanchnic nerves to the salivary center located in the medulla. The parasympathetic outputs are conducted via two different pathways including the glossopharyngeal nerve, which then innervates the otic ganglion, and, subsequently, to the parotid glands via the auriculotemporal nerve and the facial nerve through the chorda tympani nerve to the submandibular ganglia and then innervates the submandibular and sublingual glands via the lingual nerve .
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Eating Swallowing And Saliva Management
Some people with Parkinsons may find they have difficulties with eating, swallowing and saliva control at some stage of their journey with Parkinsons.
Parkinsons can cause the muscles in the jaw and face to become stiff which affects the control of chewing and swallowing.
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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Embarrassing Symptoms Of Parkinsons Disease
Some symptoms that may occur in people with Parkinsons disease are not typical of it and so people noticing them may misunderstand them. These symptoms can be particularly embarrassing in social situations where other people witness their discomfort. They distress some people so much that they avoid company other than close friends or family. Most of these symptoms are caused by Parkinsons but some are side effects of the medicines used to treat it. All the symptoms tend to fluctuate in relation to the medication, and some people had learnt to adjust their medicine regime to minimise these effects.
Eating can cause embarrassment in several ways. Both tremor and dyskinesia affect the physical job of cutting up food and directing it into the mouth . Several people had a problem with a piece of steak or chicken that might fly off the plate as they tried to cut it up, or they had a choking fit if they unwisely took too big a piece into their mouth. Humphrey disliked eating out with friends because he tended to drop things.
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Other Relevant Information Sheets
- EX2: Physiotherapy and Parkinsons Disease
- NM2.1: Speech and Language Therapy in Parkinsons Disease
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