Excessive drooling in neurological diseases such as Parkinson's disease , cerebral palsy , stroke and traumatic brain injury

Chronic sialorrhoea (excessive salivation and drooling) happens when neurological conditions cause problems with swallowing.

Chronic sialorrhoea and excessive saliva accumulation can occur because of dysfunction or weakness of the muscles in the mouth and face

• is a common secondary symptom of many neurological conditions such as Parkinson's disease, cerebral palsy, stroke and traumatic brain injury and is often caused by swallowing issues and poor lip seal

Complications of sialorrhoea may include poor oral hygiene, bad breath, perioral dermatitis, dehydration, eating and speaking difficulties, sleep disturbance and fatigue. Sialorrhoea may also increase the risk of aspiration pneumonia if the saliva is inhaled

• this may affect mortality and is more prevalent in older people

Sialorrhoea, and the resulting excessive drooling, also has:

• a psychosocial effect on patients including embarrassment, decreased self-esteem and the potential for social isolation
• can also increase the burden on caregivers who may already be helping the patient manage their neurological condition. For example, the patient may need more frequent changes of clothing or bibs, and this extra care can lead to depression and anxiety for the caregivers

NICE clinical experts stated that the burden of sialorrhoea may depend on the underlying neurological condition, the age and social activity of the person with sialorrhoea and their view of the severity of the drooling

• also was considered the third most troublesome symptom of Parkinson's disease

Treatment is usually standard (non-drug) care such as using bibs, speech and language therapy, and occupational therapy. But some people may take anticholinergic drugs to reduce the amount of saliva produced (1).

Botulinum neurotoxin type A) is recommended, within its marketing authorisation, as an option for treating chronic sialorrhoea caused by neurological conditions in adults (1)

Reference:

• NICE (October 2019). Xeomin (botulinum neurotoxin type A) for treating chronic sialorrhoea