Morgante Francesca, Bavikatte Ganesh, Anwar Fahim, Mohamed Biju
Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom; Department of Experimental and Clinical Medicine, University of Messina.
Department of Rehabilitation Medicine, The Walton Centre NHS Foundation Trust, Liverpool, UK.
Ther Adv Neurol Disord. 2019 Nov 28;12:1756286419888601. doi: 10.1177/1756286419888601. eCollection 2019.
Sialorrhoea is a frequent symptom of neurological diseases (e.g. Parkinson's disease, motor neuron disease, cerebral palsy, and stroke) and is defined as excessive saliva accumulation leading to unintentional loss of saliva from the mouth. Sialorrhoea increases the overall burden on the patient and their caregivers, the impact of which can be both physical and psychosocial. Treatments for sialorrhoea range from lifestyle and behavioural guidance, to medications, surgery or radiation. Nonpharmacological interventions include advice on posture, swallowing control, cough management, dietary changes, eating and drinking techniques, and behavioural modification; however, these conservative measures may be ineffective for people with progressive neurological conditions. The pharmacological treatment of sialorrhoea is challenging because medications licensed for this purpose are limited, but treatments can include anticholinergic drugs and botulinum toxins. Surgical treatment of sialorrhoea is typically reserved as a last resort for patients. IncobotulinumtoxinA (Xeomin®) is the first botulinum toxin type A to receive US and UK marketing authorization for the symptomatic treatment of chronic sialorrhoea due to neurological disorders in adults. In this review, we discuss and compare the frequency and method of administration, location of treatment delivery, approximate annual costs and main side effects of botulinum toxin and different anticholinergic drugs. Management of patients with chronic neurological conditions requires input from multiple specialist teams and thus a multidisciplinary team (MDT) approach is considered fundamental to ensure that care is consistent and tailored to patients' needs. To ensure that adult patients with neurological conditions receive the best care and sialorrhoea is well managed, we suggest a potential clinical care pathway for sialorrhoea with a MDT approach, which healthcare professionals could aspire to.
流涎是神经疾病（如帕金森病、运动神经元病、脑瘫和中风）的常见症状，定义为唾液过度积聚导致唾液不自主从口腔流出。流涎增加了患者及其护理人员的总体负担，其影响涉及身体和心理社会方面。流涎的治疗方法包括生活方式和行为指导、药物治疗、手术或放疗。非药物干预措施包括姿势建议、吞咽控制、咳嗽管理、饮食改变、饮食技巧以及行为矫正；然而，这些保守措施对患有进行性神经疾病的患者可能无效。流涎的药物治疗具有挑战性，因为为此目的获批的药物有限，但治疗方法可包括抗胆碱能药物和肉毒毒素。流涎的手术治疗通常是患者的最后选择。因卡肉毒毒素A（Xeomin®）是首个获得美国和英国市场授权，用于对症治疗成人神经疾病所致慢性流涎的A型肉毒毒素。在本综述中，我们讨论并比较了肉毒毒素和不同抗胆碱能药物的给药频率和方法、治疗部位、大致年度费用及主要副作用。慢性神经疾病患者的管理需要多个专科团队的参与，因此多学科团队（MDT）方法被认为是确保护理连贯且符合患者需求的基础。为确保患有神经疾病的成年患者获得最佳护理且流涎得到妥善管理，我们建议采用MDT方法的流涎潜在临床护理路径，医疗保健专业人员可努力遵循。
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