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Zeitschrift für Palliativmedizin 2004; 5(2): 41-46
DOI: 10.1055/s-2003-814941
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Palliative Therapie des vermehrten Speichelflusses (Sialorrhö)

Palliative Care of SialorrhoeaPeter  P.  Urban1 , Martin  Weber2
  • 1Klinik und Poliklinik für Neurologie, Mainz
  • 2III. Medizinische Klinik der Johannes Gutenberg Universität, Mainz
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Publication History

Publication Date:
15 July 2004 (online)

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Zusammenfassung

Der unwillkürliche Speichelfluss aus dem Mund ist ein häufiges Symptom bei Patienten mit ausgeprägten Schluckstörungen, das unabhängig von der Ursache der Dysphagie auftritt. Der Speichelfluss hat negative Auswirkungen auf die Lebensqualität und die Fähigkeit zur Artikulation. Die Therapie beruht im Wesentlichen auf einer Reduktion des in normaler Menge produzierten Speichels. Eingesetzt werden systemische (Anticholinergika) und nur lokal wirksame (Injektion von Botulinumtoxin) Therapieverfahren, die auch unter palliativen Aspekten für den Patienten Gewinn bringend eingesetzt werden können.

Abstract

Drooling of saliva is a clinically relevant symptom in dysphagia independently from its etiology. Sialorrhea creates relevant hygienic and psychosocial difficulties for patients and their caregivers and interferes with articulation resulting in a decrease in quality of live. The general therapeutic concept bases mainly on the reduction of the normally produced saliva using systemic anticholinergic medications or a local treatment, like the injection of botulinum toxin.

Schlüsselwörter

Hypersalivation - Sialorrhö - Dysphagie - Botulinumtoxin - Palliativmedizin

Key words

Drooling - hypersalivation - sialorrhoea - dysphagia - botulinumtoxin - palliative care

Literatur

  • 1 Lucas V, Schofield L. Treatment of drooling.  European Journal of Palliative Care. 2000;  7 5-7
    PubMedSearch in Google Scholar
  • 2 Borasio G D, Voltz R. Palliative care in amyotrophic lateral sclerosis.  J Neurol. 1997;  244, Suppl 4 S11-17
    PubMedSearch in Google Scholar
  • 3 Meng N H, Wang T G, Lien I N. Dysphagia in patients with brainstem stroke: incidence and outcome.  Am J Phys Med Rehabil. 2000;  79 170-175
    PubMedSearch in Google Scholar
  • 4 Bateson M C, Gibberd F B, Wilson R S. Salivary symptoms in Parkinson disease.  Arch Neurol. 1973;  29 274-275
    PubMedSearch in Google Scholar
  • 5 Bartolome G, Buchholz D W, Hannig C, Neumann S, Prosiegel M, Schröter-Morasch H. et al .Diagnostik und Therapie neurologisch bedingter Schluckstörungen. Stuttgart; Fischer 1993
    Search in Google Scholar
  • 6 Glickman S, Deaney C N. Treatment of relative sialorrhoea with botulinum toxin type A: description and rationale for an injection procedure with case report.  Eur J Neurol. 2001;  8 567-571
    CrossrefPubMedSearch in Google Scholar
  • 7 Pal P K, Calne D B, Calne S, Tsui J K. Botulinum toxin A as treatment for drooling saliva in PD.  Neurology. 2000;  54 244-247
    PubMedSearch in Google Scholar
  • 8 Giess R, Naumann M, Werner E, Riemann R, Beck M, Puls I. et al . Injections of botulinum toxin A into the salivary glands improve sialorrhoea in amyotrophic lateral sclerosis.  J Neurol Neurosurg Psychiatry. 2000;  69 121-123
    Search in Google Scholar
  • 9 Tscheng D Z. Sialorrhea - therapeutic drug options.  Ann Pharmacother. 2002;  36 1785-1790
    CrossrefPubMedSearch in Google Scholar
  • 10 Blasco P A, Stansbury J C. Glycopyrrolate treatment of chronic drooling.  Arch Pediatr Adolesc Med. 1996;  150 932-935
    CrossrefPubMedSearch in Google Scholar
  • 11 Bushara K O. Sialorrhea in amyotrophic lateral sclerosis: a hypothesis of a new treatment - botulinum toxin A injections of the parotid glands.  Med Hypotheses. 1997;  48 337-339
    CrossrefPubMedSearch in Google Scholar
  • 12 Shaari C M, Wu B L, Biller H F, Chuang S K, Sanders I. Botulinum toxin decreases salivation from canine submandibular glands.  Otolaryngol Head Neck Surg. 1998;  118 452-457
    PubMedSearch in Google Scholar
  • 13 Mancini F, Zangaglia R, Cristina S, Sommaruga M G, Martignoni E, Nappi G. et al . Double-blind, placebo-controlled study to evaluate the efficacy and safety of botulinum toxin type A in the treatment of drooling in parkinsonism.  Mov Disord. 2003;  18 685-688
    CrossrefPubMedSearch in Google Scholar
  • 14 Ellies M, Laskawi R, Rohrbach-Volland S, Arglebe C. Up-to-date report of botulinum toxin therapy in patients with drooling caused by different etiologies.  J Oral Maxillofac Surg. 2003;  61 454-457
    CrossrefPubMedSearch in Google Scholar
  • 15 Tan E K, Lo Y L, Seah A, Auchus A P. Recurrent jaw dislocation after botulinum toxin treatment for sialorrhoea in amyotrophic lateral sclerosis.  J Neurol Sci. 2001;  190 95-97
    CrossrefPubMedSearch in Google Scholar
  • 16 Porta M, Gamba M, Bertacchi G, Vaj P. Treatment of sialorrhoea with ultrasound guided botulinum toxin type A injection in patients with neurological disorders.  J Neurol Neurosurg Psychiatry. 2001;  70 538-540
    CrossrefPubMedSearch in Google Scholar
  • 17 Ellies M, Laskawi R, Rohrbach-Volland S, Rodel R, Beuche W. Sekretionshemmung exokriner Drüsen des Kopf-Hals-Bereiches durch Applikation von Botulinum Toxin A.  HNO. 2001;  49 807-813
    Search in Google Scholar
  • 18 Ellies M, Laskawi R, Rohrbach-Volland S, Arglebe C, Beuche W. Botulinum toxin to reduce saliva flow: selected indications for ultrasound-guided toxin application into salivary glands.  Laryngoscope. 2002;  112 82-86
    Search in Google Scholar
  • 19 Borg M, Hirst F. The role of radiation therapy in the management of sialorrhea.  Int J Radiat Oncol Biol Phys. 1998;  41 1113-1119
    CrossrefPubMedSearch in Google Scholar
  • 20 Stalpers L J, Moser E C. Results of radiotherapy for drooling in amyotrophic lateral sclerosis.  Neurology. 2002;  58 1308
    PubMedSearch in Google Scholar
  • 21 Andersen P M, Gronberg H, Franzen L, Funegard U. External radiation of the parotid glands significantly reduces drooling in patients with motor neurone disease with bulbar paresis.  J Neurol Sci. 2001;  191 111-114
    CrossrefPubMedSearch in Google Scholar
  • 22 Walker M J, Chaudhuri P K, Wood D C, Das Gupta T K. Radiation-induced parotid cancer.  Arch Surg. 1981;  116 329-331
    PubMedSearch in Google Scholar
  • 23 Nunn J H. Drooling: review of the literature and proposals for management.  J Oral Rehabil. 2000;  27 735-743
    Search in Google Scholar
  • 24 Heider A, Engels B, Hartmann-Klosterkotter U, Kress M, Niederle N. Hypersalivation als Leitsymptom einer Meningiosis neoplastica bei hochmalignem Non-Hodgkin-Lymphom.  Dtsch Med Wochenschr. 1993;  118 19-22
    PubMedSearch in Google Scholar
  • 25 Spivak B, Adlersberg S, Rosen L, Gonen N, Mester R, Weizman A. Trihexyphenidyl treatment of clozapine-induced hypersalivation.  Int Clin Psychopharmacol. 1997;  12 213-215
    PubMedSearch in Google Scholar
  • 26 Calderon J, Rubin E, Sobota W L. Potential use of ipatropium bromide for the treatment of clozapine-induced hypersalivation: a preliminary report.  Int Clin Psychopharmacol. 2000;  15 49-52
    PubMedSearch in Google Scholar
  • 27 Dreyfuss P, Vogel D, Walsh N. The use of transdermal scopolamine to control drooling. A case report.  Am J Phys Med Rehabil. 1991;  70 220-222
    PubMedSearch in Google Scholar
  • 28 Dunlop R, Hockley J. Transdermal hyoscine and drooling (letter).  Palliat Med. 1990;  4 328-329
    PubMedSearch in Google Scholar
  • 29 Talmi Y P, Finkelstein Y, Zohar Y, Laurian N. Reduction of salivary flow with Scopoderm TTS.  Ann Otol Rhinol Laryngol. 1988;  97 128-130
    Search in Google Scholar
  • 30 Brodtkorb E, Wyzocka-Bakowska M M, Lillevold P E, Sandvik L, Saunte C, Hestnes A. Transdermal scopolamine in drooling.  J Ment Defic Res. 1988;  32 233-237
    PubMedSearch in Google Scholar
  • 31 Siegel L K, Klingbeil M A. Control of drooling with transdermal scopolamine in a child with cerebral palsy.  Dev Med Child Neurol. 1991;  33 1013-1014
    PubMedSearch in Google Scholar
  • 32 Lewis D W, Fontana C, Mehallick L K, Everett Y. Transdermal scopolamine for reduction of drooling in developmentally delayed children.  Dev Med Child Neurol. 1994;  36 484-486
    PubMedSearch in Google Scholar
  • 33 Hoenig J F, Merten H A, Merten B. Medikamentöse Hemmung der Speichelsekretion nach Oropharynxtumorresektion.  Dtsch Med Wochenschr. 1992;  117 518-519
    PubMedSearch in Google Scholar
  • 34 Zeppetella G. Nebulized scopolamine in the management of oral dribbling: three case reports.  J Pain Symptom Manage. 1999;  17 293-295
    CrossrefPubMedSearch in Google Scholar
  • 35 Doyle J, Walker P, Bruera E. Nebulized scopolamine.  J Pain Symptom Manage. 2000;  19 327-328
    CrossrefPubMedSearch in Google Scholar
  • 36 Hyson H C, Johnson A M, Jog M S. Sublingual atropine for sialorrhea secondary to parkinsonism: a pilot study.  Mov Disord. 2002;  17 1318-1320
    CrossrefPubMedSearch in Google Scholar
  • 37 Mueller P R, Biswal S, Halpern E F, Kaufman J A, Lee M J. Interventional radiologic procedures: patient anxiety, perception of pain, understanding of procedure, and satisfaction with medication - a prospective study.  Radiology. 2000;  215 684-688
    CrossrefPubMedSearch in Google Scholar
  • 38 Stern L M. Preliminary study of glycopyrrolate in the management of drooling.  J Paediatr Child Health. 1997;  33 52-54
    PubMedSearch in Google Scholar
  • 39 Olsen A K, Sjogren P. Oral glycopyrrolate alleviates drooling in a patient with tongue cancer.  J Pain Symptom Manage. 1999;  18 300-302
    CrossrefPubMedSearch in Google Scholar
  • 40 Lucas V, Amass C. Use of enteral glycopyrrolate in the management of drooling.  Palliat Med. 1998;  12 207-208
    PubMedSearch in Google Scholar
  • 41 Neverlien P O, Sorumshagen L, Eriksen T, Grinna T, Kvalshaugen H, Lind A B. Glycopyrrolate treatment of drooling in an adult male patient with cerebral palsy.  Clin Exp Pharmacol Physiol. 2000;  27 320-322
    CrossrefPubMedSearch in Google Scholar
  • 42 Rashid H, Long J D, Wadleigh R G. Management of secretions in esophageal cancer patients with glycopyrrolate.  Ann Oncol. 1997;  8 198-199
    CrossrefPubMedSearch in Google Scholar
  • 43 Mier R J, Bachrach S J, Lakin R C, Barker T, Childs J, Moran M. Treatment of sialorrhea with glycopyrrolate: A double-blind, dose-ranging study.  Arch Pediatr Adolesc Med. 2000;  154 1214-1218
    CrossrefPubMedSearch in Google Scholar
  • 44 Strutt R, Fardell B, Chye R. Nebulized glycopyrrolate for drooling in a motor neuron patient.  J Pain Symptom Manage. 2002;  23 2-3
    CrossrefPubMedSearch in Google Scholar
  • 45 Newall A R, Orser R, Hunt M. The control of oral secretions in bulbar ALS/MND.  J Neurol Sci. 1996;  139, Suppl 43-44
    CrossrefPubMedSearch in Google Scholar
  • 46 Serrano-Duenas M. Treatment of sialorrhea in Parkinson's disease patients with clonidine. Double-blind, comparative study with placebo.  Neurologia. 2003;  18 2-6
    PubMedSearch in Google Scholar
  • 47 Fritze J, Elliger T. Pirenzepine for clozapine-induced hypersalviation.  Lancet. 1995;  346 1034
    PubMedSearch in Google Scholar

PD Dr. Peter P. Urban

Department of Neurology · University of Mainz

Langenbeckstraße 1

55101 Mainz

Phone: + 49/6131-174473

Fax: + 49/6131-175625

Email: urban@neurologie.klinik.uni-mainz.de