Iona Pearson1, Stella A Glasmacher2,3, Judith Newton2,3,4, Emily Beswick2,3,4, Arpan R Mehta2,3,4,5, Richard Davenport3,4,5, Siddharthan Chandran2,3,4,5,6, Suvankar Pal2,3,4,5,7. 1. College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom. 2. Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom. 3. Anne Rowling Regenerative Neurology Clinic, Royal Infirmary, Edinburgh, United Kingdom. 4. Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, United Kingdom. 5. Department of Clinical Neurosciences, NHS Lothian, Edinburgh, United Kingdom. 6. UK Dementia Research Institute at University of Edinburgh, Edinburgh, United Kingdom. 7. Department of Neurology, NHS Forth Valley, Larbert, United Kingdom.
Abstract
INTRODUCTION: Saliva problems are common and distressing for people with motor neuron disease (pwMND). Despite clinical guidelines for assessment and treatment, management of saliva problems has received little research attention. OBJECTIVE: We aimed to investigate the prevalence of saliva problems in pwMND, their association with clinical factors, and their management practice using a highly curated population-based register for motor neuron disease (MND) with 99% case ascertainment. METHODS: We conducted an analysis of pwMND diagnosed between January 2015 and October 2019 using the Scottish MND Register (CARE-MND [Clinical, Audit, Research, and Evaluation of MND]). The association between clinical factors and saliva problems was investigated using univariate and multivariable logistic regression; results are reported as odds ratio (OR) and 95% confidence intervals. A survey of health-care professionals involved in the care of pwMND was performed to contextualize the findings. RESULTS: 939 pwMND were included. Prevalence of saliva problems was 31.3% (294). Bulbar onset (OR 9.46 [4.7, 19.2]; p < 0.001) but not age, sex, time to diagnosis, or MND subtype were independently associated with the presence of saliva problems in multivariable regression, and 52.7% (155) of those with saliva problems received pharmacological management. The most commonly used medications were hyoscine, amitriptyline, carbocisteine, glycopyrrolate, and atropine. Evidence base (8, 72.7%) and local guidelines (10, 90.9%) were cited as the most important factors influencing treatment decision by survey respondents (n = 11). CONCLUSION: Saliva problems are common and associated with bulbar onset MND. A substantial proportion of pwMND with saliva problems did not receive recommended treatments. Future research is required to determine the relative efficacy of individual pharmacological treatments.
INTRODUCTION: Saliva problems are common and distressing for people with motor neuron disease (pwMND). Despite clinical guidelines for assessment and treatment, management of saliva problems has received little research attention. OBJECTIVE: We aimed to investigate the prevalence of saliva problems in pwMND, their association with clinical factors, and their management practice using a highly curated population-based register for motor neuron disease (MND) with 99% case ascertainment. METHODS: We conducted an analysis of pwMND diagnosed between January 2015 and October 2019 using the Scottish MND Register (CARE-MND [Clinical, Audit, Research, and Evaluation of MND]). The association between clinical factors and saliva problems was investigated using univariate and multivariable logistic regression; results are reported as odds ratio (OR) and 95% confidence intervals. A survey of health-care professionals involved in the care of pwMND was performed to contextualize the findings. RESULTS: 939 pwMND were included. Prevalence of saliva problems was 31.3% (294). Bulbar onset (OR 9.46 [4.7, 19.2]; p < 0.001) but not age, sex, time to diagnosis, or MND subtype were independently associated with the presence of saliva problems in multivariable regression, and 52.7% (155) of those with saliva problems received pharmacological management. The most commonly used medications were hyoscine, amitriptyline, carbocisteine, glycopyrrolate, and atropine. Evidence base (8, 72.7%) and local guidelines (10, 90.9%) were cited as the most important factors influencing treatment decision by survey respondents (n = 11). CONCLUSION: Saliva problems are common and associated with bulbar onset MND. A substantial proportion of pwMND with saliva problems did not receive recommended treatments. Future research is required to determine the relative efficacy of individual pharmacological treatments.
Authors: Renée Walhout; Esther Verstraete; Martijn P van den Heuvel; Jan H Veldink; Leonard H van den Berg Journal: Amyotroph Lateral Scler Frontotemporal Degener Date: 2017-10-16 Impact factor: 4.092
Authors: Esther V Hobson; Alexander McGeachan; Ammar Al-Chalabi; Siddharthan Chandran; Francesca Crawley; David Dick; Colette Donaghy; John Ealing; Cathy M Ellis; George Gorrie; C Oliver Hanemann; Timothy Harrower; Agam Jung; Tahir Majeed; Andrea Malaspina; Karen Morrison; Richard W Orrell; Hardev Pall; Ashwin Pinto; Kevin Talbot; Martin R Turner; Timothy L Williams; Carolyn A Young; Pamela J Shaw; Christopher J McDermott Journal: Amyotroph Lateral Scler Frontotemporal Degener Date: 2013-05-07 Impact factor: 4.092