Botulinum toxin type-B improves sialorrhea and quality of life in bulbaronset amyotrophic lateral sclerosis.

BACKGROUND: Sialorrhea is a disabling problem in bulbaronset amyotrophic lateral sclerosis (ALS). Botulinum toxin (BTX) type A and B have been proposed as alternatives to traditional treatments. OBJECTIVES: To evaluate the efficacy and safety of BTX type B in the treatment of sialorrhea in patients with bulbar-onset ALS. METHODS: Open-label prospective study of BTX type B injections in parotids (1000 U) and submandibular (250 U) glands using anatomic landmarks. Primary outcome was rate of responders (improvement > 50% on visual analogue scales (VAS) of severity and disability of sialorrhea) 1 month post-treatment. Other outcomes included subjective (drooling and quality of daily living questionnaires) and objective (cotton roll weights and number of paper handkerchiefs used) evaluations. Safety evaluations included questionnaires regarding brain stem symptoms. RESULTS: Sixteen ALS patients were included. At 1 month the rate of responders was 75% with a mean reduction of 70% in severity and disabling VASs. Fifteen patients (94 %) reported some benefit with drooling reduction. In objective measurements there was a reduction over 60 % in saliva production and in the number of handkerchiefs used. Onset of effect occurred within 3 days. Most patients reported better quality of living. The most frequent side-effects were viscous saliva, local pain, chewing weakness and respiratory infection. There were no changes in blood pressure or cardiac rate. At 3 months, there was still a positive effect in all outcomes. All patients except one manifested their willingness to repeat treatment. CONCLUSIONS: Anatomic guided BTX type B injections seem effective and safe to treat sialorrhea in bulbar-onset ALS.

A standardised mini pig model for in vivo investigations of anticholinergic effects on bladder function and salivation.

PURPOSE: The objective was to validate an in vivo model for evaluation of pharmacological effects on bladder function taking the most predominant anticholinergic side effect (hyposalivation) into account. Therefore, two anticholinergic properties (propiverine hydrochloride and tolterodine-L(+)-tartrate) were used to test the in vivo model. Sacral anterior root stimulation (SARS) was performed to induce reproducible and standardized bladder contractions. To evaluate hyposalivation standardised salivavary flow measurements by stimulating the lingual nerve was performed in addition to SARS. MATERIALS AND METHODS: 10 male mini pigs were anaesthetised. The carotid artery was cannulated for blood pressure measurement and the jugular vein for administration of propiverine 0.4 mg kg(-1) b.w. and tolterodine 0.06 mg kg(-1) b.w. For stimulation-induced salivary flow measurements both lingual nerves were exposed and a cuff electrode was placed around the nerves. The bladder was exposed and a cystostomy catheter was inserted to performed cystometrographic measurements during SARS. RESULTS: In all experiments, for each animal reproducible intravesical pressure values (pves) and salivary flow rates were elicited during electrostimulation before administration of the drug. Bladder pressure: After administration of propiverine, neurostimulation-induced rise in pves had fallen by 60% from the initial value. After administration of tolterodine pves had fallen by about 50%. After additional administration of atropine pves decreased to about 15% of the initial value for both drugs. Salivation: After propiverine salivary flow had fallen by 61%. Inhibition of salivary flow under tolterodine was about 56%. Additional administration of atropine led in both drugs to a nearly complete blockade of salivation. Heart rate (HR) and blood pressure (BP): Directly following intravenous administration of both drugs, a short-term and reversible period of mild but significant fluctuations in HR was observed. There was also a slight but non-significant rise in blood pressure. CONCLUSIONS: This model allows comparative investigations of various drugs with bladder inhibitory properties in terms of acute efficacy and side effects.

M(3) muscarinic acetylcholine receptor plays a critical role in parasympathetic control of salivation in mice.

The M(1) and M(3) subtypes are the major muscarinic acetylcholine receptors in the salivary gland and M(3) is reported to be more abundant. However, despite initial reports of salivation abnormalities in M(3)-knockout (M(3)KO) mice, it is still unclear which subtype is functionally relevant in physiological salivation. In the present study, salivary secretory function was examined using mice lacking specific subtype(s) of muscarinic receptor. The carbachol-induced [Ca(2+)](i) increase was markedly impaired in submandibular gland cells from M(3)KO mice and completely absent in those from M(1)/M(3)KO mice. This demonstrates that M(3) and M(1) play major and minor roles, respectively, in the cholinergically induced [Ca(2+)](i) increase. Two-dimensional Ca(2+)-imaging analysis revealed the patchy distribution of M(1) in submandibular gland acini, in contrast to the ubiquitous distribution of M(3). In vivo administration of a high dose of pilocarpine (10 mg kg(-1), s.c.) to M(3)KO mice caused salivation comparable to that in wild-type mice, while no salivation was induced in M(1)/M(3)KO mice, indicating that salivation in M(3)KO mice is caused by an M(1)-mediated [Ca(2+)](i) increase. In contrast, a lower dose of pilocarpine (1 mg kg(-1), s.c.) failed to induce salivation in M(3)KO mice, but induced abundant salivation in wild-type mice, indicating that M(3)-mediated salivation has a lower threshold than M(1)-mediated salivation. In addition, M(3)KO mice, but not M(1)KO mice, had difficulty in eating dry food, as shown by frequent drinking during feeding, suggesting that salivation during eating is mediated by M(3) and that M(1) plays no practical role in it. These results show that the M(3) subtype is essential for parasympathetic control of salivation and a reasonable target for the drug treatment and gene therapy of xerostomia, including Sjögren's syndrome.

Calcium concentration of salivary glands and saliva after chemical or surgical sympathectomy.

Calcium concentration of the submaxillary (SM) gland of adult rat was increased to 2-3 times control levels 24 h after a single high dose of reserpine (RES) (5 mg/kg body weight), 6-hydroxydopamine (6-OHDA) (20 mg/kg body weight), or surgical removal of a superior cervical ganglion (Sx). The increase could also be induced within 24 h after a single injection of lower doses of RES (0.05, 0.5 mg/kg body weight). Increase in calcium concentration in the parotid (PA) was not found under any of the above conditions, but did occur transiently at times within 24 h. The increase in glandular calcium concentration was found to be temporally related to depletion of norepinephrine (NE). The time frame for initiation of calcium changes was not the same for chemical and surgical sympathectomy (Sx). Increase in calcium concentration occurred after onset of sympathectomy-induced degeneration secretion; the onset varied with the kind of sympathectomy, and was seen 1 h after drug administration with either RES or 6-OHDA, but not until about 13 h after surgical Sx. Similarly, NE was markedly depleted, but later with surgical than with chemical Sx. Furthermore, with both kinds of sympathectomy, depletion of NE occurred earlier with PA than with SM, since normal basal levels of NE of SM are 3 times as great (3400 ng/g wet weight), compared with PA levels (1300 ng/g wet weight). The fact that NED was the neurotransmitter eliciting the degeneration secretion was confirmed physiologically by examination of the composition of this secretion.(ABSTRACT TRUNCATED AT 250 WORDS)

[Neural control of saliva secretion. Review of questions on special neurosecretory functions of the facial nerve]. / Die neurale Steuerung der Speichelsekretion. Ubersicht zu Fragen spezieller neurosekretorischer Funktionen des Fazialis.

Fifty years ago, anatomists and physiologists still held the opinion that the N. facialis had a purely motor fuction without any sensory or secretory components. With respect to the previously only occasionally mentioned possibility of an additional neurosecretory function of the N. facialis, clinical and experimental, especially neurophysiological research and experiences of the last five decades have however led to results which are being discussed under particular consideration of the neural control of salivary secretion. In this connection, side-functions are discussed that are just appearing in outlines and have not yet been fully cleared up, for example questions regarding an internal secretion of certain parts of the facial nerve, especially related to the patotid gland. In connection with this question, the author considered it necessary to refer to some medical-historical findings of earlier times.

The sympathetic superior cervical ganglia as peripheral neuroendocrine centers.

The superior cervical ganglia (SCG) provide sympathetic innervation to the pineal gland, cephalic blood vessels, the choroid plexus, the eye, carotid body and the salivary and thyroid glands. Removal of the ganglia brings about several neuroendocrine changes in mammals, including the disruption of water balance in pituitary stalk-sectioned rats, and the alteration of normal photoperiodic control of reproduction in hamsters, ferrets, voles, rams and goats. These effects are commonly attributed to pineal denervation. However pinealectomy does not always mimic ganglionectomy in its neuroendocrine sequelae. This paper discusses several examples illustrating the lack of homology of ganglia and pineal removal, including the prolactin release brought about by gonadal steroids in spayed rats, the changes in drinking behaviour caused by ganglionectomy and the control of goitrogenic response to methylmercaptoimidazole in rats. All these examples indicate that SCG removal, at least as far as for neuroendocrinologists and pineal experimenters are concerned, should not be considered simply as "pineal denervation". A functionally relevant link between SCG and the hypothalamus may occur in rats inasmuch as ganglionectomy depresses norepinephrine uptake and increases the number and responses of alpha-adrenoceptors in medial basal hypothalamus. Lastly the SCG are active points of concurrency for hormone signals, as revealed by the metabolic changes induced by steroid and anterior pituitary hormones in these structures even in the absence of intact preganglionic connections, as well as by the existence of putative receptors for some of the hormones, namely, estradiol, testosterone and corticosteroids. The SCG appear to constitute a peripheral neuroendocrine center.