title: Radiotherapy reduces sialorrhea in amyotrophic lateral sclerosis.
abstract: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder. Sialorrhea is a frequent problem in ALS patients with bulbar symptoms, because of progressive weakness of oral, lingual and pharyngeal muscles. This prospective study aimed to investigate the putative effect of palliative single-dose radiotherapy on problematic sialorrhea in patients with ALS. Twenty patients with ALS and problematic drooling were included; 14 were given radiotherapy with a single fraction of 7.5 Grey (Gy). Five patients were treated with botulinum toxin A (BTX-A) injections (20 U) into the parotid glands; two of these were later given radiotherapy. Symptom assessment, clinical examination and measurements of salivary flow (ml/min) were performed before and after treatment (1-2 weeks, 3 months). Salivary secretion was significantly reduced after radiation treatment, with a mean reduction of 60% (1 week) and 51% (2 weeks). Three months post-treatment, 21% reduction of the salivary secretion was observed compared with salivation before treatment. Mean salivary flow was not reduced after BTX-A treatment in five patients. No serious side-effects were observed with either of the two treatment modalities. Single-dose radiotherapy (7.5 Gy) significantly reduces sialorrhea and is an effective and safe palliative treatment in patients with ALS.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway. evelyn.neppelberg@odont.uib.no
authors.forename: E
authors.initials: E
authors.lastname: Neppelberg
authors.forename: D F
authors.initials: DF
authors.lastname: Haugen
authors.forename: L
authors.initials: L
authors.lastname: Thorsen
authors.forename: O-B
authors.initials: OB
authors.lastname: Tysnes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications* / Q000503:physiopathology*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010306:Parotid Gland / Q000503:physiopathology / Q000528:radiation effects; D011300:Preoperative Care; D011446:Prospective Studies; D011829:Radiation Dosage; D011878:Radiotherapy / Q000379:methods*; D012469:Salivary Glands / Q000503:physiopathology / Q000528:radiation effects*; D012796:Sialography; D012798:Sialorrhea / Q000209:etiology* / Q000503:physiopathology / Q000532:radiotherapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019274:Botulinum Toxins, Type A