Treatment of sialorrhea in Parkinson’s disease

Sialorrhea is a common disabling nonmotor symptom of Parkinson’s disease. It can lead to several ill effects such as poor orodental hygiene, speech and feeding difficulty, depressive symptoms, poor quality of life, and aspiration pneumonia. It most likely occurs secondary to swallowing dysfunction due to a combination of factors such as lingual bradykinesia, oropharyngeal dysphagia, and esophageal dysmotility, leading to impaired salivary clearance. Various tools are available for its objective assessment to assess drooling in patients with Parkinson’s disease. The treatment options include use of anticholinergic medications and optimization of dopaminergic therapy. However, their use is limited due to the occurrence of adverse effects. Botulinum toxin injections into the parotid and submandibular glands is the most effective and safest treatment available at present.