|
Ask the Doc: Q & A with Edward Kasarskis, MD, PhD Edward Kasarskis, M.D., Ph.D. is Director of the multidisciplinary ALS Center at the University of Kentucky Neuroscience Center in Lexington, Kentucky, professor in the Department of Neurology at the University of Kentucky, and Chief of Neurology at the VA Medical Center in Lexington KY.
Q: Over the last two months I have developed a horrible problem with saliva building up in my mouth and causing me to drool. I’ve tried several medications but they don’t seem to last very long. My physician has said he wants to inject Botox directly into a gland. What should I do? A: Drooling can be a major problem for many people with ALS. Not only is it uncomfortable, but it can increase your risk of getting aspiration pneumonia, be embarrassing in social situations, and even, on occasion, make it harder for you to hold down a job. Drooling can easily be mis-understood and can be interpreted as suggesting that you are not mentally alert. But of course, you are! First, a little background on why you are drooling. A person with ALS manufactures the same amount of saliva as does someone without the disease. Because you have trouble with swallowing, jaw weakness, neck muscle weakness, difficulty bringing your lips to a tight closure, or perhaps a combination of those factors, saliva tends to build up in your mouth and you drool. It is very common with those who have “bulbar” involvement in ALS. For those who can’t tolerate these drugs or who don’t get the desired effect, botulinum toxin (Botox, Myobloc) may help. Your parotid glands, which are on the side of your face near your ear, make a watery saliva. An injection of botulinum toxin into one or both glands is typically effective to decrease saliva production. It takes a week or so to see results. Unfortunately, the injections need to be repeated about every two to three months, depending on how you respond, and the drug is a bit expensive. Another approach is to use x-ray therapy to irradiate the parotid glands and decrease saliva production. Side effects can include dry mouth or soreness, and additional treatments may be needed. None of these treatments is perfect and new therapeutic approaches need to be developed. My colleagues and I are working on a new radiotherapy approach and hope to refine the method over the next year or so. If you would like to submit questions for a future Q & A, please send your questions to Amber Walters at awalters@alsa-national.org. Please understand that we won’t be able to address all questions and we won’t be able to respond to individuals personally. |
