Sialorrhea: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum ToxinsReportar como inadecuado




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1

Department of Neurology, Yale School of Medicine, 15 York Street LLCI-920 New Haven, CT 06520, USA

2

Department of Neurology, Case Western Reserve University, Cleveland, OH 44106, USA





*

Author to whom correspondence should be addressed.



Abstract Sialorrhea or excessive drooling is a major issue in children with cerebral palsy and adults with neurodegenerative disorders. In this review, we describe the clinical features, anatomy and physiology of sialorrhea, as well as a review of the world literature on medical treatment using Yale University’s search engine; including but not limited to Medline and Erasmus. Level of drug efficacy is defined according to the guidelines of American Academy of Neurology. Current medical management is unsatisfactory. Topical agents scopolamine and tropicamide and oral agents glyccopyrolate combined render a level B evidence probably effective; however, this treatment is associated with troublesome side effects. Double-blind and placebo-controlled studies of botulinum toxin BoNT provide a level A evidence for type B two class I studies; effective and established and both overall and individual B level of evidence for OnabotulinumtoxinA A-Ona and AbobotulinumtoxinA A-Abo; these are probably effective. For IncobotulinumtoxinA A-Inco, the level of evidence is U insufficient due to lack of blinded studies. Side effects are uncommon; transient and comparable between the two types of toxin. A clinical note at the end of this review comments on fine clinical points. Administration of BoNTs into salivary glands is currently the most effective way of treating sialorrhea. View Full-Text

Keywords: botulinum neurotoxins; botox; drooling; pytialis; double-blind; therapy; topical agents; oral agents botulinum neurotoxins; botox; drooling; pytialis; double-blind; therapy; topical agents; oral agents





Autor: Amanda Amrita Lakraj 1, Narges Moghimi 2 and Bahman Jabbari 1,*

Fuente: http://mdpi.com/



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