Objective: To leverage patient survey data and expert opinion to develop recommendations for managing sialorrhea in patients with Parkinson’s disease (PD).

Background: Sialorrhea, or drooling, is defined as accumulation and spillage of saliva out of the mouth. It constitutes one of the most frequent and bothersome complaints of patients with PD, affecting up to 84% of them. It is a distressing and challenging condition that may result in social isolation, embarrassment, depression, skin infections, and aspiration pneumonia. To better understand the burden of sialorrhea on PD patients, Parkinson’s Europe carried out a worldwide patient survey that showed that sialorrhea remains an underrecognized and undertreated issue in PD patients, despite the availability of therapeutic options. Therefore, there is an opportunity to improve the management of these patients.

Method: Based on the analysis of the Sialorrhea Survey Report, a multidisciplinary panel of experts identified current barriers to sialorrhea diagnosis and management and proposed clear recommendations to improve these aspects of care.

Results: To overcome the barriers to diagnosis and treatment of sialorrhea, it is important to develop a holistic approach to patient management that puts the patient at the center and empowers patients and caregivers to talk to their healthcare team about drooling and its impact on them. It is essential to better educate patients, family members, caregivers, and healthcare professionals about sialorrhea; to engage all actors to actively discuss sialorrhea and measure its impact on quality of life; and to recognize the role of speech and language therapy and botulinum toxin as first-line therapies.

Conclusion: A shift in the treatment paradigm for sialorrhea in PD patients is emerging. To achieve better recognition and treatment of sialorrhea, the authors recommend: 1) Increase awareness and education of sialorrhea as a non-motor symptom of PD to facilitate an earlier diagnosis; 2) Speech and language therapy and/or botulinum toxin injections as first-line therapies, and 3) Caution use of central-acting anticholinergic treatments.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/recommendations-to-tackle-under-recognition-and-under-treatment-of-sialorrhea-in-parkinsons-disease-is-it-time-for-a-paradigm-shift/