Abstract Details

Title Quantitative Reduction of Sialorrhea After Unilateral Parotid Electron Beam Radiotherapy in Debilitating Neurological Disorders

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) S56 - Neuromuscular Therapeutics (5:06 PM-5:18 PM)

Poster/Presentation
Number 009

Background Sialorrhea causes significant problems for patients with dysphagia. Current treatment includes anticholinergics and injection of botulinum toxinto the parotid glands, the primary source of watery saliva. Previous studies found that EBRT was clinically effective in reducing sialorrhea but the time course, extent, and duration following EBRT has not been defined.

Objective To measure the amount of saliva produced after unilateral electron beam radiotherapy (EBRT) and to evaluate patients’ subjective responses to treatment.

Design/Methods Fifteen ALS patients with medically refractory sialorrhea were treated with unilateral EBRT, total dose 15Gy in three 5Gy fractions after anatomic mapping with CT scanning. The amount of unstimulated saliva produced was determined, weighing tared dental rolls before EBRT and at specified times thereafter. Surveys assessed the impact of sialorrhea and response to EBRT. Measurements were dichotomized into epochs of <30 days or ≥30 days post treatment. An additional 39 patients previously received EBRT; saliva measurements from these patients were included in a separate cross-sectional analysis totaling 54 patients.

Results Compared to pre-treatment levels, saliva production was reduced by 60% in all patients (at <30 days p=0.0006; at ≥30 days p=0.0004). In the cross-sectional study, the reduction appeared to be permanent at least out to 2 years. Significant clinical improvements included a decrease in choking episodes (at <30 days p=0.029; at ≥30 days p=0.025) and a subjective decrease in salivation (at ≥30 days p=0.017). Side effects included minor, self-limited erythema post radiation in one person.

Conclusions This study confirms that unilateral EBRT is safe, effective, and leads to a long-lasting 60% reduction in unstimulated saliva. The origin of sialorrhea is multifactorial and includes dysphagia, poor head positioning, and weakness of lip seal, each requiring separate evaluation and management. EBRT is in the management armamentarium to reduce qsialorrhea and can be used in conjunction with anticholinergics if needed.

Authors/Disclosures
Edward J. Kasarskis, MD, PhD, FAAN (UK Healthcare) PRESENTER	The institution of Dr. Kasarskis has received research support from Healey Platform Trial Group. The institution of Dr. Kasarskis has received research support from Amylyx . The institution of Dr. Kasarskis has received research support from Alexion. The institution of Dr. Kasarskis has received research support from Woolsey . Dr. Kasarskis has a non-compensated relationship as a Director of ALSA-supported clinic at the University of Kentucky with ALS Association that is relevant to AAN interests or activities.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Meha A. Joshi, MD	No disclosure on file
Richard Kryscio	No disclosure on file

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