1.
Overactive Bladder in Frail Older Adults.
Shaw, C, Wagg, A
Drugs & aging. 2020;(8):559-565
Abstract
Overactive bladder (OAB) and frailty are multidimensional syndromes, and the prevalence of both increases with age. Little evidence exists for a direct association between OAB and frailty, but urinary urgency may well be a precursor of frailty in older people. Frail older adults are no less deserving of treatment than fit older adults, and lifestyle, behavioral, and pharmacological interventions remain the primary options for treatment, with some evidence for efficacy. Data on onabotulinumtoxinA therapy or percutaneous tibial nerve stimulation in frail older adults are sparse. Frail older adults are often excluded from drug trials, but evidence is accumulating that antimuscarinics and, to a lesser extent, beta-adrenergic agonists are safe, well-tolerated, and effective in older adults. Cognitive impairment associated with frailty should not be used as justification for avoiding the use of antimuscarinics. More studies are required to better understand the association between OAB and frailty, as both are associated with poor outcomes and may be amenable to intervention. Drug trials for OAB treatments should be encouraged to include frail older adults, as this population is highly affected yet often excluded.
2.
Botulinum toxin injection to improve functional independence and to alleviate parenting stress in a child with advanced pantothenate kinase-associated neurodegeneration: A case report and literature review.
Lin, CI, Chen, KL, Kuan, TS, Lin, SH, Lin, WP, Lin, YC
Medicine. 2018;(20):e10709
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Abstract
RATIONALE Pantothenate kinase-associated neurodegeneration (PKAN) is a rare autosomal recessive disease. Progressive motor symptoms such as dystonia and spasticity begin in childhood and relentlessly become incapacitating later in life. Treatments including anticholinergics and iron chelation are usually ineffective. Botulinum toxin type A (BoNT-A) is effective for adult patients with dystonia or spasticity. PATIENT CONCERNS We reported a 10-year-old female patient with advanced PKAN, manifesting as generalized dystonia and spasticity. DIAGNOSIS The patient was diagnosed with PKAN by a pediatric neurologist. INTERVENTIONS The patient received BoNT-A injection. OUTCOMES The effect was obvious at four weeks after the injection, with an improvement of 25% in Barry-Albright Dystonia Scale and 4% in Functional Independence Measure for Children score. Furthermore, there was a 3.8% reduction in Parenting Stress Index Short Form score and 8.3% improvement in Pain and Impact of Disability domain in the score of Cerebral Palsy Quality of Life for Children. LESSONS BoNT-A injection was effective to improve functional independence and to alleviate stress of caregivers in the patient with advanced PKAN.
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Controlling sialorrhoea: a review of available treatment options.
Potulska, A, Friedman, A
Expert opinion on pharmacotherapy. 2005;(9):1551-4
Abstract
Sialorrhoea (drooling or excessive salivation) is a common symptom of many neurological diseases (e.g., amyotropic lateral sclerosis, cerebral palsy and Parkinson's disease) and otolaryngologic diseases (tumours of upper aerodigestive tract). It is mostly caused by poor oral and facial muscle control in patients with swallowing dysfunction (secondary sialorrhoea). However, some cases of sialorrhoea are due to hypersecretion of saliva. These cases represent so-called primary sialorrhoea.