Glycopyrrolate for sialorrhea in Parkinson disease: A randomized, double-blind, crossover trial
ABSTRACT Sialorrhea affects approximately 75% of patients with Parkinson disease (PD). Sialorrhea is often treated with anticholinergics, but central side effects limit their usefulness. Glycopyrrolate (glycopyrronium bromide) is an anticholinergic drug with a quaternary ammonium structure not able to cross the blood-brain barrier in considerable amounts. Therefore, glycopyrrolate exhibits minimal central side effects, which may be an advantage in patients with PD, of whom a significant portion already experience cognitive deficits.
To determine the efficacy and safety of glycopyrrolate in the treatment of sialorrhea in patients with PD.
We conducted a 4-week, randomized, double-blind, placebo-controlled, crossover trial with oral glycopyrrolate 1 mg 3 times daily in 23 patients with PD. The severity of the sialorrhea was scored on a daily basis by the patients or a caregiver with a sialorrhea scoring scale ranging from 1 (no sialorrhea) to 9 (profuse sialorrhea).
The mean (SD) sialorrhea score improved from 4.6 (1.7) with placebo to 3.8 (1.6) with glycopyrrolate (p = 0.011). Nine patients (39.1%) with glycopyrrolate had a clinically relevant improvement of at least 30% vs 1 patient (4.3%) with placebo (p = 0.021). There were no significant differences in adverse events between glycopyrrolate and placebo treatment.
Oral glycopyrrolate 1 mg 3 times daily is an effective and safe therapy for sialorrhea in Parkinson disease. Classification of evidence: This study provides Class I evidence that glycopyrrolate 1 mg 3 times daily is more effective than placebo in reducing sialorrhea in patients with Parkinson disease during a 4-week study.
- SourceAvailable from: Johanna G Kalf
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- "We investigated the prevalence of diurnal and nocturnal drooling in a large cohort of community-dwelling outpatients with PD. Seventy-one percent of patients confirmed problems with saliva or drooling, which is roughly the prevalence that is usually cited in publications [1, 5, 16, 20]. However, here we demonstrate that actual diurnal drooling, i.e. dribbling of saliva from the mouth while awake, is reported by only 28% of PD patients. "
ABSTRACT: Drooling as symptom of Parkinson's disease (PD) has thus far been poorly defined. This uncertainty is reflected by high variations in published prevalence rates. The aim of this study was to investigate the prevalence of saliva loss versus accumulation of saliva as a possible preliminary stage, and diurnal drooling versus nocturnal drooling. In addition, we evaluated the association between drooling severity and the severity of facial and oral motor disorders. We collected age, disease duration, UPDRS III and Hoehn & Yahr stage from 104 consecutive outpatients with PD. Diurnal and nocturnal drooling was evaluated with a validated questionnaire (ROMP-saliva). A speech pathologist, blinded for drooling severity, rated facial expression, involuntary mouth opening and difficulty with nose breathing and also interviewed patients about sleeping position and nose-breathing during the night. Thirty patients (29%) had no complaints with saliva control ('non-droolers'), 45 patients (43%) experienced accumulation of saliva or only nocturnal drooling ('pre-droolers'), and 29 (28%) had diurnal drooling (24 of which also drooled during the night; 'droolers'). The droolers had longer disease duration (10 vs. 7 years, p = 0.01) and drooling was independently associated with involuntary mouth opening (OR = 2.0; 95% CI 1.02-3.99) and swallowing complaints (OR = 1.2; 95% CI 1.03-1.31). Diurnal drooling-defined as dribbling of saliva while awake-is present in about 28% of PD patients. This is less than usually reported. Diurnal drooling typically appeared later in the disease course. The association with oral motor behavior should encourage the development of behavioral treatment approaches.Journal of Neurology 06/2011; 259(1):119-23. DOI:10.1007/s00415-011-6138-2 · 3.38 Impact Factor
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ABSTRACT: The cytokine-induced activation cascade of NF-kappaB in mammals and the activation of the morphogen dorsal in Drosophila embryos show striking structural and functional similarities (Toll/IL-1, Cactus/I-kappaB, and dorsal/NF-kappaB). Here we demonstrate that these parallels extend to the immune response of Drosophila. In particular, the intracellular components of the dorsoventral signaling pathway (except for dorsal) and the extracellular Toll ligand, spätzle, control expression of the antifungal peptide gene drosomycin in adults. We also show that mutations in the Toll signaling pathway dramatically reduce survival after fungal infection. Antibacterial genes are induced either by a distinct pathway involving the immune deficiency gene (imd) or by combined activation of both imd and dorsoventral pathways.Cell 10/1996; 86(6):973-83. DOI:10.1016/S0092-8674(00)80172-5 · 32.24 Impact Factor
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ABSTRACT: Sialorrhea is a common and often debilitating, socially isolating and embarrassing symptom for patients with Parkinson disease (PD). The treatment of sialorrhea involves the management of saliva production, and is complicated in this disease by the risk of aspiration. Two novel approaches to the treatment of this symptom in PD have recently been published.Nature Reviews Neurology 08/2010; 6(8):423-4. DOI:10.1038/nrneurol.2010.107 · 15.36 Impact Factor