Botulinum neurotoxin type A treatment for sialorrhea in central nervous system diseases
Date
2018-09-20
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Abstract
Sialorröad ehk liigset süljevoolust defineeritakse kui keha võimetust kontrollida suuneelu kogunenud sekreeti, mille tulemuseks on liigne sülje voolamine. Sialorröa võib esineda nii lastel kui täiskasvanutel krooniliste neuroloogiliste haiguste korral, nagu laste tserebraalparalüüs, amüotroofne lateraalskleroos ja Parkinsoni tõbi. Probleem ei ole tingitud mitte niivõrd süljeerituse rohkusest, vaid neelamisreflekside langusest, lihaste nõrkusest ja koordineerimatust tegevusest.
Botulismitoksiin A (BNT-A) on kasutusel olnud mitmete kesknärvisüsteemi häirete (düstooniad, spastilisus) ravis mitmekümne aasta jooksul; uue näidustusena on lisandunud liigse süljevooluse vähendamine. BNT-A süstimine süljenäärmetesse vähendab süljeeritust, seega kergeneb väiksema süljekoguse alla neelamine. Sülje ja suuõõne mikrofloora muutused võivad põhjustada häireid suuõõne tervises, mille oluliseks komponendiks on sülje puhastav ja antibakteriaalne toime.
Käesoleva töö eesmärk oli uurida BNT-A ravi efektiivsust ja ohutust süljenäärmete süstimisel sialorröa ravis kesknärvisüsteemi haigustega patsientidel. Lisaks ravimi toimeefektile oli uuringuküsimuseks muutused suuõõne mikroflooras ja sülje omadustes, mis võivad olla mõjutatud BNT-A süstimise tagajärjel tekkinud süljekoguse vähenemisest.
Uuringu tulemused näitasid süljevooluse vähenemist raviga statistiliselt olulisel määral. Hambumushäire mõjutas tserebraalparalüüsiga patsientidel süljeerituse intensiivsust. Sialorröad esines rohkem Parkinsoni tõvega haigetel, kelle domineerivaks häireks oli bradükineesia – liigutuste aeglus ja kohmakus -, ja vähem treemor-dominantse kliinilise alatüübi korral. Sülje koostises ja S. mutansi hulgas muutust ei esinenud, kuid laktobatsillide hulk näitas statistiliselt olulist tõusu.
Süljevooluse ravi BNT-A süstidega on efektiivne, kuid võib viia suuõõne isepuhastumisvõime langusele.
Drooling or sialorrhea is defined as an inability to control oral secretions, resulting in excessive saliva accumulation in the oropharynx. Sialorrhea may occur in several neurological disorders including infantile cerebral palsy, amyotrophic lateral sclerosis and Parkinson's disease. Mostly the problem is not related to overproduction of saliva but is a result of changes in co-ordinated control mechanism and reflectory process of swallowing musculature. Botulinum neurotoxin (BNT-A) has been used for treatment of several neurological disorders (dystonias, spasticity) for decades, but recently its effectiveness in treating sialorrhoea has been reported as a novel option. BNT-A decreases salivation. Changes in saliva could affect oral health, because saliva has a cleansing and antibacterial effect. The aim of the study was to investigate the safety and efficacy of BNT-A injections into salivary glands for the treatment of sialorrhea in patients with central nervous system diseases We also aimed to assess changes in saliva amount that might affect the oral microflora and saliva characteristics. The results of the study showed that saliva amount decreased statistically significantly after BNT-A treatment. Malocclusion in cerebral palsy patients affected salivary flow intenstity. Parkinson's disease patients with akinesia-rigidity had more sialirrhea compared to patients with tremor. No statistically significant changes in salivary composition and the level of S. mutans found, but the level of Lactobacilli counts raised after BNT-A injections. Intrasalivary gland injections of BNT-A are effective in the treatment of drooling but could decrease self-cleaning ability.
Drooling or sialorrhea is defined as an inability to control oral secretions, resulting in excessive saliva accumulation in the oropharynx. Sialorrhea may occur in several neurological disorders including infantile cerebral palsy, amyotrophic lateral sclerosis and Parkinson's disease. Mostly the problem is not related to overproduction of saliva but is a result of changes in co-ordinated control mechanism and reflectory process of swallowing musculature. Botulinum neurotoxin (BNT-A) has been used for treatment of several neurological disorders (dystonias, spasticity) for decades, but recently its effectiveness in treating sialorrhoea has been reported as a novel option. BNT-A decreases salivation. Changes in saliva could affect oral health, because saliva has a cleansing and antibacterial effect. The aim of the study was to investigate the safety and efficacy of BNT-A injections into salivary glands for the treatment of sialorrhea in patients with central nervous system diseases We also aimed to assess changes in saliva amount that might affect the oral microflora and saliva characteristics. The results of the study showed that saliva amount decreased statistically significantly after BNT-A treatment. Malocclusion in cerebral palsy patients affected salivary flow intenstity. Parkinson's disease patients with akinesia-rigidity had more sialirrhea compared to patients with tremor. No statistically significant changes in salivary composition and the level of S. mutans found, but the level of Lactobacilli counts raised after BNT-A injections. Intrasalivary gland injections of BNT-A are effective in the treatment of drooling but could decrease self-cleaning ability.
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Keywords
central nervous system diseases, salivary secretion, treatment, botulin