Ipratropium Bromide Spray as Treatment for Sialorrhea in Parkinson's Disease
Identifieur interne : 002671 ( Main/Exploration ); précédent : 002670; suivant : 002672Ipratropium Bromide Spray as Treatment for Sialorrhea in Parkinson's Disease
Auteurs : Teri R. Thomsen [Canada] ; Wendy R. Galpem [Canada] ; Abena Asante [Canada] ; Tamara Arenovich [Canada] ; Susan H. Fox [Canada]Source :
- Movement disorders [ 0885-3185 ] ; 2007.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
- Aged, Aged, 80 and over, Cholinergic Antagonists (administration & dosage), Cholinergic Antagonists (adverse effects), Cross-Over Studies, Female, Humans, Ipratropium (administration & dosage), Ipratropium (adverse effects), Ipratropium bromide, Male, Middle Aged, Nervous system diseases, Parkinson Disease (complications), Parkinson disease, Saliva (drug effects), Sialorrhea, Sialorrhea (drug therapy), Sialorrhea (etiology), Spray, Treatment, Treatment Failure.
- MESH :
- chemical , administration & dosage : Cholinergic Antagonists, Ipratropium.
- chemical , adverse effects : Cholinergic Antagonists, Ipratropium.
- complications : Parkinson Disease.
- drug effects : Saliva.
- drug therapy : Sialorrhea.
- etiology : Sialorrhea.
- Aged, Aged, 80 and over, Cross-Over Studies, Female, Humans, Male, Middle Aged, Treatment Failure.
Abstract
Sialorrhea is a significant problem in advanced Parkinson's disease (PD). Current treatment options include systemic anticholinergics which frequently cause side effects. We hypothesized that sublingual application of ipratropium bromide spray, an anticholinergic agent that does not cross the blood brain barrier, may reduce drooling without systemic side effects. We performed a randomized, double blind, placebo-controlled, crossover study in 17 subjects with PD and bothersome drooling. Patients were randomized to receive ipratropium bromide or placebo (one to two sprays, maximum of four times per day) for 2 weeks followed by a 1 week washout and crossover for further 2 weeks of treatment. The primary outcome was an objective measure of weight of saliva production. Secondary outcomes were subjective rating of severity and frequency of sialorrhoea using home diaries, United Parkinson's Disease Rating Scale (UPDRS) part II salivation subscore, parkinsonian disability using UPDRS, and adverse events. Ipratropium bromide spray had no significant effect on weight of saliva produced. There was a mild effect of treatment on subjective measures of sialorrhea. There were no significant adverse events. Ipratropium bromide spray was well tolerated in subjects with PD. Although it did not affect objective measures of saliva production, further studies in parkinsonism may be warranted.
Affiliations:
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Thomsen</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Movement Disorders Centre, Toronto Western Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Galpem, Wendy R" sort="Galpem, Wendy R" uniqKey="Galpem W" first="Wendy R." last="Galpem">Wendy R. Galpem</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Movement Disorders Centre, Toronto Western Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Asante, Abena" sort="Asante, Abena" uniqKey="Asante A" first="Abena" last="Asante">Abena Asante</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Movement Disorders Centre, Toronto Western Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Arenovich, Tamara" sort="Arenovich, Tamara" uniqKey="Arenovich T" first="Tamara" last="Arenovich">Tamara Arenovich</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Biostatistical Consulting Service, Clinical Research Department, Centre for Addiction and Mental Health</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>4 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Fox, Susan H" sort="Fox, Susan H" uniqKey="Fox S" first="Susan H." last="Fox">Susan H. Fox</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Movement Disorders Centre, Toronto Western Hospital, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author></analytic><series><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Cholinergic Antagonists (administration & dosage)</term><term>Cholinergic Antagonists (adverse effects)</term><term>Cross-Over Studies</term><term>Female</term><term>Humans</term><term>Ipratropium (administration & dosage)</term><term>Ipratropium (adverse effects)</term><term>Ipratropium bromide</term><term>Male</term><term>Middle Aged</term><term>Nervous system diseases</term><term>Parkinson Disease (complications)</term><term>Parkinson disease</term><term>Saliva (drug effects)</term><term>Sialorrhea</term><term>Sialorrhea (drug therapy)</term><term>Sialorrhea (etiology)</term><term>Spray</term><term>Treatment</term><term>Treatment Failure</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Cholinergic Antagonists</term><term>Ipratropium</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Cholinergic Antagonists</term><term>Ipratropium</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>Saliva</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Sialorrhea</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Sialorrhea</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Cross-Over Studies</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Treatment Failure</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Pathologie du système nerveux</term><term>Maladie de Parkinson</term><term>Bromure d'ipratropium</term><term>Embrun</term><term>Traitement</term><term>Sialorrhée</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Sialorrhea is a significant problem in advanced Parkinson's disease (PD). Current treatment options include systemic anticholinergics which frequently cause side effects. We hypothesized that sublingual application of ipratropium bromide spray, an anticholinergic agent that does not cross the blood brain barrier, may reduce drooling without systemic side effects. We performed a randomized, double blind, placebo-controlled, crossover study in 17 subjects with PD and bothersome drooling. Patients were randomized to receive ipratropium bromide or placebo (one to two sprays, maximum of four times per day) for 2 weeks followed by a 1 week washout and crossover for further 2 weeks of treatment. The primary outcome was an objective measure of weight of saliva production. Secondary outcomes were subjective rating of severity and frequency of sialorrhoea using home diaries, United Parkinson's Disease Rating Scale (UPDRS) part II salivation subscore, parkinsonian disability using UPDRS, and adverse events. Ipratropium bromide spray had no significant effect on weight of saliva produced. There was a mild effect of treatment on subjective measures of sialorrhea. There were no significant adverse events. Ipratropium bromide spray was well tolerated in subjects with PD. Although it did not affect objective measures of saliva production, further studies in parkinsonism may be warranted.</div></front></TEI><affiliations><list><country><li>Canada</li></country><region><li>Ontario</li></region><settlement><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="Canada"><region name="Ontario"><name sortKey="Thomsen, Teri R" sort="Thomsen, Teri R" uniqKey="Thomsen T" first="Teri R." last="Thomsen">Teri R. Thomsen</name></region><name sortKey="Arenovich, Tamara" sort="Arenovich, Tamara" uniqKey="Arenovich T" first="Tamara" last="Arenovich">Tamara Arenovich</name><name sortKey="Asante, Abena" sort="Asante, Abena" uniqKey="Asante A" first="Abena" last="Asante">Abena Asante</name><name sortKey="Fox, Susan H" sort="Fox, Susan H" uniqKey="Fox S" first="Susan H." last="Fox">Susan H. Fox</name><name sortKey="Galpem, Wendy R" sort="Galpem, Wendy R" uniqKey="Galpem W" first="Wendy R." last="Galpem">Wendy R. Galpem</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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