抄読会の事前資料(2020年10月9日)

  • 2020.10.02 Friday
  • 09:00

2020年10月から12月にかけての3回はALS進行期で対処に難渋することの多い「Sialorrhoea(流涎)」に関連した論文を紹介します。
プレゼンテーション10分、ディスカッション10〜20分を予定しています。

今回は論文2本です。といってもすべてを紹介することはできません。

,蓮Sialorrhoea」に関連した部分のみの紹介です。

抄読会の事前学習資料(2020年10月9日) を読んでおいて頂くと内容がわかりやすいと思います。

 

Respiratory Failure in Amyotrophic Lateral Sclerosis (Review)

 

Niedermeyer S, Murn M, Choi PJ. Respiratory Failure in Amyotrophic Lateral Sclerosis. Chest. 2019 Feb;155(2):401-408. doi: 10.1016/j.chest.2018.06.035. Epub 2018 Jul 7. PMID: 29990478.

 

Modalities of oral secretion management include anticholinergic agents, botulinum toxin injection, and radiation therapy. Choice is provider dependent but usually starts with the least invasive approach. Anticholinergic agents such as scopolamine (oral or transdermal patches), amitriptyline, atropine, and glycopyrrolate are common first-line therapies. If the response is minimal, a different anticholinergic agent should be selected. Combinations of agents rarely provide significant clinical improvement and only increase the potential side effects. Commonly reported adverse side effects include confusion, drowsiness, and urinary retention. For patientswho achieve little benefit fromthese agents or who find the side effects intolerable, botulinum toxin injection into the submandibular and/or parotid gland is an option. Unfortunately, there is substantial variability in significant clinical response between patients and a paucity of data regarding dosing or frequency of administration. The most prominent concern is paralyzing surrounding musculature and worsening bulbar function. For patients who do not respond well to other therapies, high-beam irradiation to the salivary glands is an option. Again, there are few data regarding optimal dosing and duration of therapy (Table 1). (21,22)

 

Drooling Reduction Intervention randomised trial (DRI): comparing the efficacy and acceptability of hyoscine patches and glycopyrronium liquid on drooling in children with neurodisability (Randomized Controlled Trial)

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