title: A review of options for treating sialorrhea in amyotrophic lateral sclerosis.
abstract: Sialorrhea or drooling represents quite a common problem in patients with amyotrophic lateral sclerosis (ALS). In this review, we describe the possible treatments for this issue. Current medical management is not always effective: anticholinergic drugs (atropine, glycopyrrolate, amitriptyline, hyoscyamine, and transdermal scopolamine) are often used, but there is very little evidence of their effectiveness in patients with ALS. More invasive treatments, such as botulinum toxin injections and/or radiation therapy in the salivary glands, can be considered when anticholinergic drugs are not effective. In this review, we also explore the possible surgical options for treatment of sialorrhea. Although no specific studies have been conducted on patients with ALS, surgical therapies might represent a valid option for treatment of sialorrhea since there is no tachyphylaxis or need for repeated therapeutic sessions.
authors.affiliation: Don Carlo Gnocchi Foundation, Milan, Italy. pabanfi@dongnocchi.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Banfi
authors.affiliation: Unit of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy and the Department of Pathophysiology and Transplantation, Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Ticozzi
authors.affiliation: Don Carlo Gnocchi Foundation, Milan, Italy.
authors.forename: Agata
authors.initials: A
authors.lastname: Lax
authors.affiliation: San Giuseppe Hospital, Ospedale Classificato, Istituto di Ricovero e Cura a Carattere Scientifico Multimedica, Milan, Italy.
authors.forename: Giulia Andrea
authors.initials: GA
authors.lastname: Guidugli
authors.affiliation: Respiratory Diseases Unit, Hospital of Sestri Levante, Genoa, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Nicolini
authors.affiliation: Unit of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy and the Department of Pathophysiology and Transplantation, Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Silani
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000150:complications*; D019468:Disease Management; D006801:Humans; D012798:Sialorrhea / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
keywords: amyotrophic lateral sclerosis; aspiration pneumonia; botulinum toxin; drooling; quality of life; radiotherapy; salivary glands; sialorrhea; surgical intervention