Thomsen Teri R, Galpern Wendy R, Asante Abena, Arenovich Tamara, Fox Susan H
Movement Disorders Centre, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Mov Disord. 2007 Nov 15;22(15):2268-73. doi: 10.1002/mds.21730.
Sialorrhea is a significant problem in advanced Parkinson's disease (PD). Current treatment options include systemic anticholinergics which frequently cause side effects. We hypothesized that sublingual application of ipratropium bromide spray, an anticholinergic agent that does not cross the blood brain barrier, may reduce drooling without systemic side effects. We performed a randomized, double blind, placebo-controlled, crossover study in 17 subjects with PD and bothersome drooling. Patients were randomized to receive ipratropium bromide or placebo (one to two sprays, maximum of four times per day) for 2 weeks followed by a 1 week washout and crossover for further 2 weeks of treatment. The primary outcome was an objective measure of weight of saliva production. Secondary outcomes were subjective rating of severity and frequency of sialorrhoea using home diaries, United Parkinson's Disease Rating Scale (UPDRS) part II salivation subscore, parkinsonian disability using UPDRS, and adverse events. Ipratropium bromide spray had no significant effect on weight of saliva produced. There was a mild effect of treatment on subjective measures of sialorrhea. There were no significant adverse events. Ipratropium bromide spray was well tolerated in subjects with PD. Although it did not affect objective measures of saliva production, further studies in parkinsonism may be warranted.
流涎是晚期帕金森病（PD）的一个重要问题。目前的治疗选择包括全身用抗胆碱能药物，但这些药物经常会引起副作用。我们推测，舌下应用异丙托溴铵喷雾剂（一种不穿过血脑屏障的抗胆碱能药物）可能会减少流口水，且无全身副作用。我们对17名患有PD且流口水严重的受试者进行了一项随机、双盲、安慰剂对照的交叉研究。患者被随机分为接受异丙托溴铵或安慰剂治疗（一到两喷，每天最多四次），为期2周，随后有1周的洗脱期，然后交叉进行另外2周的治疗。主要结局是唾液分泌量的客观测量。次要结局包括使用家庭日记对流涎严重程度和频率进行主观评分、统一帕金森病评定量表（UPDRS）第二部分流涎亚评分、使用UPDRS评估帕金森病残疾程度以及不良事件。异丙托溴铵喷雾剂对唾液分泌量没有显著影响。治疗对流涎的主观测量有轻微影响。没有显著的不良事件。PD患者对异丙托溴铵喷雾剂耐受性良好。虽然它没有影响唾液分泌的客观测量，但可能有必要对帕金森病进行进一步研究。
