PO175 Management of thin saliva symptoms in patients with motor neurone disease

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SummaryExcess thin saliva symptoms cause significant morbidity in patients with Motor Neuron Disease (MND). There is no good consensus with regards to medical management of such symptoms. This cross-sectional study aimed to assess the prevalence and time to onset of saliva symptoms in MND patients with various presenting symptoms. It also evaluated the prescribing practices for thin saliva symptoms in Addenbrooke’s MND Care Centre and those of neurologists in East Anglia with reference to the current 2016 NICE guidelines. 44.2% of MND patients (n=86) were found to experience saliva symptoms during their disease course. Bulbar-onset MND patients were found to have a significantly shorter time between the onset of the first symptom to the development of salivary symptoms as compared to spinal-onset MND patients (14±2.3 months versus 39.5±9.8 months). It was found that the first- and second-line treatment of choice for thin saliva symptoms of neurologists in East Anglia involved trialling various preparations of anticholinergic agents. Of the anticholinergic preparations used, atropine eye drops and amitriptyline were best tolerated judging from discontinuations and numbers reporting side effects. Four out of six neurologists would only consider using or referring patients for intraglandular botulinum toxin (BoNT) injections following failure of anticholinergic therapy. Concern over possible side effects and lack of adequate staff training accounts for the discrepancy between NICE recommendations and current utilisation of BoNT therapy for thin saliva symptoms.

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