Problems with excessive saliva affect approximately half of the MND population, but there is little evidence guiding the management of these problems. A recent survey of clinicians caring for MND patients estimated that these problems are poorly controlled in approximately 42% of patients with these problems.
We undertook a study to assess the approaches being taken to manage these problems by clinicians with a special interest in caring for MND patients. Nineteen clinicians from 17 centres across the UK provided case report forms for a total of 366 patients.
Anticholinergics are multi-purpose medications which have been shown to reduce the production of saliva. Seven different types of these medications were used in over 70 doses. This variation in management approaches highlights the lack of evidence guiding the management of this problem. Hyoscine patches were most frequently effective and an effective early stage therapy; however, their efficacy was limited by adverse effects particularly a skin reaction at the site of the application to the patch. Moreover, these drugs often failed to provide sufficient symptom control as disease progressed. Botulinum toxin injections into the salivary glands were a frequently used and often effective alternative, used in patients whose symptoms could not be controlled by anticholinergic medication.