title: A multicentre evaluation of oropharyngeal secretion management practices in amyotrophic lateral sclerosis.
abstract: Failure to clear oral secretions can be debilitating for patients with amyotrophic lateral sclerosis (ALS), but the treatment of this symptom is poorly defined and there is no consensus on best practice. The objective of this study was to identify the treatments that are commonly prescribed, and to describe how experienced clinicians manage a patient with treatment resistant symptoms. Twenty-three clinicians were approached, of which 19 from 16 centres across the UK provided case report forms for a total of 119 ALS patients identified as having problematic oral secretions. The use of five anticholinergics, salivary gland botulinum toxin injections, conservative management approaches and carbocisteine were reported. Of the 72 patients who were evaluated following the initiation of a first anticholinergic, 61% had symptomatic improvement. Only 19% of patients achieved symptomatic improvement with the use of an alternative anticholinergic when an initial anticholinergic achieved no symptomatic improvement. Problems with thick and thin secretions often coexisted, with 37% of patients receiving treatment for both types of problem. In conclusion, a variety of treatment options are employed by expert clinicians for problematic oral secretions in ALS patients. The variation in management highlights the need for further prospective research in this area.
authors: a Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, & Academic Directorate of Neurosciences, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield.
authors: Alexander J
authors: AJ
authors: McGeachan
authors: a Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, & Academic Directorate of Neurosciences, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield.
authors: Esther V
authors: EV
authors: Hobson
authors: b King's College London, Institute of Psychiatry , Department of Clinical Neuroscience , London.
authors: Ammar
authors: A
authors: Al-Chalabi
authors: a Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, & Academic Directorate of Neurosciences, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield.
authors: Jodie
authors: J
authors: Stephenson
authors: c Department of Neurology , Royal Infirmary of Edinburgh , Edinburgh.
authors: Siddharthan
authors: S
authors: Chandran
authors: d Department of Neurology , West Suffolk NHS Foundation Trust , Bury St. Edmunds.
authors: Francesca
authors: F
authors: Crawley
authors: e Department of Neurology , Norfolk and Norwich University Hospital , Norwich.
authors: David
authors: D
authors: Dick
authors: f Department of Neurology , Royal Victoria Hospital , Belfast.
authors: Colette
authors: C
authors: Donaghy
authors: g Motor Neuron Disease Care and Research Centre , Kings College Hospital , London.
authors: Cathy M
authors: CM
authors: Ellis
authors: h Institute of Neurological Sciences, Southern General Hospital , Glasgow.
authors: George
authors: G
authors: Gorrie
authors: i Institute of Translational and Stratified Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry , Plymouth.
authors: C Oliver
authors: CO
authors: Hanemann
authors: j Department of Neurology , Royal Devon and Exeter Foundation Trust Hospital.
authors: Timothy
authors: T
authors: Harrower
authors: k Department of Neurology , Leeds General Infirmary , Leeds.
authors: Agam
authors: A
authors: Jung
authors: l Centre for Neuroscience and Trauma , Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, & Department of Neurology, Basildon University Hospital , Basildon.
authors: Andrea
authors: A
authors: Malaspina
authors: m Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, and Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust , Birmingham.
authors: Karen E
authors: KE
authors: Morrison
authors: n Department of Clinical Neuroscience , University College London Institute of Neurology, London, & MND Care and Research Centre, National Hospital for Neurology and Neurosurgery , Queen Square , London.
authors: Richard W
authors: RW
authors: Orrell
authors: o Oxford University Nuffield Department of Clinical Neurosciences , John Radcliffe Hospital , Oxford.
authors: Kevin
authors: K
authors: Talbot
authors: o Oxford University Nuffield Department of Clinical Neurosciences , John Radcliffe Hospital , Oxford.
authors: Martin R
authors: MR
authors: Turner
authors: p Department of Neurology , Royal Victoria Infirmary , Newcastle-upon-Tyne , and.
authors: Timothy L
authors: TL
authors: Williams
authors: q The Walton Centre for Neurology and Neurosurgery , Liverpool , UK.
authors: Carolyn A
authors: CA
authors: Young
authors: a Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, & Academic Directorate of Neurosciences, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield.
authors: Pamela J
authors: PJ
authors: Shaw
authors: a Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, & Academic Directorate of Neurosciences, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield.
authors: Christopher J
authors: CJ
authors: McDermott
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications*; D001905:Botulinum Toxins / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D015331:Cohort Studies; D019468:Disease Management; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012601:Scopolamine / Q000627:therapeutic use; D012798:Sialorrhea / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D065087:Acetylcholine Release Inhibitors; D018680:Cholinergic Antagonists; D012601:Scopolamine; D001905:Botulinum Toxins
keywords: Secretion management; anticholinergics; botulinum toxin; sialorrhoea