What are the best ways to manage drooling and excessive salivation in patients with diseases such as Motor Neurone Disease (MND) who are approaching the end of their life

Record type Uncertainties identified from carers' questions
Source James Lind Alliance Palliative and end of life care Priority Setting Partnership
Why is there uncertainty? Reliable up-to-date systematic reviews have revealed important continuing uncertainties about treatment effects

Original Uncertainty

This uncertainty was identified from two professional's, and a carer's and two bereaved carer's questions

This is an indicative uncertainty and the following submissions were merged to form this one:
What is the best way to manage symptoms in advanced neurological disease: - hypersalivation / drooling - spasms.
What could I have done to have made my dad more comfortable when suction for his excess saliva wasnt working and it was the saliva that was causing problems?
My father's biggest question would be how to control his saliva and drooling?? This is a huge problem for him at the moment? Himself and his MND nurse are trying different medications and it is all trail and error!!

References to reliable up-to-date systematic reviews:

Young CA, Ellis C, Johnson J, Sathasivam S, Pih N. Treatment for sialorrhea (excessive saliva) in people with motor neuron disease/amyotrophic lateral sclerosis. Cochrane Database of Systematic Reviews 2011, Issue 5. Art. No.: CD006981. DOI: 10.1002/14651858.CD006981.pub2. Squires N, Humberstone M, Wills A, Arthur A. The use of botulinum toxin injections to manage drooling in amyotrophic lateral sclerosis/motor neurone disease: a systematic review. Dysphagia.2014;29(4):500?508 [See web page]

What is needed? Further research
Systematic reviews that need updating or extending None identified
Systematic reviews in preparation None identified
Ongoing controlled trials The effect of botulinum toxin on decrease of sialorrhea in patients with neurologic disorder [See web page] Assessment of the efficacy and the influence on swallowing function of transdermal scopolamine for ALS patinets' drooling [See web page] Study of the Safety and Efficacy of Tropicamide Thin Films to Reduce Hypersalivation in Parkinson's Patients NCT01844648


Which health conditions? Neurological conditions | Service delivery, organisation and staffing | Palliative and end of life care
What is person's age? Adult
Which types of treatments? Drug

Which Outcomes

Health related quality of life, good death, Change in symptoms or change in management of symptoms, adverse effects or complications

Record ID: Publication date:08 Sep 2015
Last reviewed date:08 Sep 2016 Publication Type:Known Uncertainty
The DUETs team endeavours to ensure that information is correct at the time of data entry