[Pharmacological therapy of sialorrhea in patients with motor neuron disease]

A comparative trial of amithryptiline and dysport (botulinic toxin type A) in the treatment of sialorrhea in patients with motor neuron disease (MND) was conducted in 10 MND patients with sialorrhea, of whom 5 were treated with subcutaneous injections of Dysport and 5 with Amithriptiline, and 6 controls without salivary dysfunction. Gravimetry and scintigraphy of salivary glands were used before and after treatment. Compared to controls, saliva production was significantly decreased in MND patients. Both amithryptilin and dysport used in mean therapeutic doses decreased sialorrhea with similar effect. However, 3 patients, receiving amythryptiline in dosage 50 mg/day, experienced side effects (constipation, accommodation disturbances, dry mouth, sleepiness and poor concentration). Reducing of amithryptiline dose, along with prescribing dysport, removed the side-effects in these patients, while sialorrhea did not increase. The authors concluded that due to high efficacy and low cost of amithryptiline therapy of sialorrhea proved to be a golden standard of palliative care in MDN. However, in these terms dysport can not be an alternative to amithryptiline in sialorrhea therapy. Nevertheless, in cases when amithryptiline treatment is accomplished with side-effects, the drug dosage can be reduced and combined with dysport.